Provider Demographics
NPI:1134569478
Name:BOWLING, TAMARA L (FNP-C)
Entity type:Individual
Prefix:
First Name:TAMARA
Middle Name:L
Last Name:BOWLING
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6995 FAIRHAVEN OVAL DR
Mailing Address - Street 2:
Mailing Address - City:MEDINA
Mailing Address - State:OH
Mailing Address - Zip Code:44256-6384
Mailing Address - Country:US
Mailing Address - Phone:724-494-6482
Mailing Address - Fax:
Practice Address - Street 1:230 QUADRAL DR
Practice Address - Street 2:STE B
Practice Address - City:WADSWORTH
Practice Address - State:OH
Practice Address - Zip Code:44281-8376
Practice Address - Country:US
Practice Address - Phone:330-336-2800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-07-01
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHCOA.14688-NP363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0088065Medicaid
OHCOA.14688-NPOtherLICENSE NUMBER
OHCOA.14688-NPOtherLICENSE NUMBER