Provider Demographics
NPI:1942473988
Name:FOWLER, COLLEEN GERALDINE
Entity Type:Individual
Prefix:MS
First Name:COLLEEN
Middle Name:GERALDINE
Last Name:FOWLER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1556 LOTUS PATH
Mailing Address - Street 2:
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33756-4421
Mailing Address - Country:US
Mailing Address - Phone:727-657-6505
Mailing Address - Fax:
Practice Address - Street 1:1556 LOTUS PATH
Practice Address - Street 2:
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33756-4421
Practice Address - Country:US
Practice Address - Phone:727-657-6505
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-10
Last Update Date:2008-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246RP1900XTechnologists, Technicians & Other Technical Service ProvidersTechnician, PathologyPhlebotomy