Provider Demographics
NPI:1255734547
Name:MCGOWEN, PAMELA S (ARNP)
Entity type:Individual
Prefix:
First Name:PAMELA
Middle Name:S
Last Name:MCGOWEN
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 1:597 W 11TH ST
Mailing Address - Street 2:
Mailing Address - City:PANAMA CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32401-2330
Mailing Address - Country:US
Mailing Address - Phone:850-872-4455
Mailing Address - Fax:850-747-5475
Practice Address - Street 1:597 W 11TH ST
Practice Address - Street 2:
Practice Address - City:PANAMA CITY
Practice Address - State:FL
Practice Address - Zip Code:32401-2330
Practice Address - Country:US
Practice Address - Phone:850-872-4455
Practice Address - Fax:850-747-5475
Is Sole Proprietor?:No
Enumeration Date:2014-10-01
Last Update Date:2015-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1750052363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLI50940Medicare UPIN
FL351272Medicare PIN
FL274657300Medicaid