Provider Demographics
NPI:1134629132
Name:MCGOWAN, STACY ELAINE (CNA)
Entity type:Individual
Prefix:MRS
First Name:STACY
Middle Name:ELAINE
Last Name:MCGOWAN
Suffix:
Gender:F
Credentials:CNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1275 SUMMIT OAKS DR E
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32221-3252
Mailing Address - Country:US
Mailing Address - Phone:904-401-4899
Mailing Address - Fax:
Practice Address - Street 1:1275 SUMMIT OAKS DR E
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32221-3252
Practice Address - Country:US
Practice Address - Phone:904-401-4899
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-02-15
Last Update Date:2022-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL300686376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide