Provider Demographics
NPI:1013603489
Name:BOVENDER, AUDRA HELENA (PA-C)
Entity type:Individual
Prefix:
First Name:AUDRA
Middle Name:HELENA
Last Name:BOVENDER
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:109 W FORTUNE ST APT 1417
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33602-3217
Mailing Address - Country:US
Mailing Address - Phone:919-412-0245
Mailing Address - Fax:
Practice Address - Street 1:5920 SANDY FORKS RD UNIT 200
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27609-3814
Practice Address - Country:US
Practice Address - Phone:919-954-3174
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-04-17
Last Update Date:2023-04-17
Deactivation Date:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical