Provider Demographics
NPI:1871840850
Name:BOWEN, MELISSA NICOLE (PA)
Entity Type:Individual
Prefix:MRS
First Name:MELISSA
Middle Name:NICOLE
Last Name:BOWEN
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:5846 INDIGO CROSSING DR
Mailing Address - Street 2:
Mailing Address - City:ROCKLEDGE
Mailing Address - State:FL
Mailing Address - Zip Code:32955-6017
Mailing Address - Country:US
Mailing Address - Phone:321-720-3372
Mailing Address - Fax:
Practice Address - Street 1:830 EXECUTIVE LN STE 140
Practice Address - Street 2:
Practice Address - City:ROCKLEDGE
Practice Address - State:FL
Practice Address - Zip Code:32955-3595
Practice Address - Country:US
Practice Address - Phone:321-635-0202
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-08-09
Last Update Date:2022-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
363A00000X
FLPA9106880363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant