Provider Demographics
NPI:1891714564
Name:STOWELL, PAULA (ARNP)
Entity Type:Individual
Prefix:
First Name:PAULA
Middle Name:
Last Name:STOWELL
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2230
Mailing Address - Street 2:
Mailing Address - City:ST AUGUSTINE
Mailing Address - State:FL
Mailing Address - Zip Code:32085-2230
Mailing Address - Country:US
Mailing Address - Phone:904-824-4990
Mailing Address - Fax:904-824-2226
Practice Address - Street 1:167 PALENCIA VILLAGE DR
Practice Address - Street 2:STE 101
Practice Address - City:ST AUGUSTINE
Practice Address - State:FL
Practice Address - Zip Code:32095-8450
Practice Address - Country:US
Practice Address - Phone:904-224-5108
Practice Address - Fax:866-334-0650
Is Sole Proprietor?:No
Enumeration Date:2006-07-19
Last Update Date:2011-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP2520572363LP0808X
FL2520572363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL003144000Medicaid
FLY6053OtherBCBS
FLY6053OtherBCBS
FL003144000Medicaid