Provider Demographics
NPI:1700287307
Name:BOWEN, MARY ELLEN (ARNP)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:ELLEN
Last Name:BOWEN
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 1:3231 SW 34TH AVE
Mailing Address - Street 2:
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34474-8489
Mailing Address - Country:US
Mailing Address - Phone:352-291-5881
Mailing Address - Fax:352-291-5898
Practice Address - Street 1:3231 SW 34TH AVE
Practice Address - Street 2:
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34474-8489
Practice Address - Country:US
Practice Address - Phone:352-291-5881
Practice Address - Fax:352-291-5898
Is Sole Proprietor?:No
Enumeration Date:2014-09-15
Last Update Date:2016-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP 9369203363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL013548900Medicaid
FLHX709ZOtherMEDICARE PTAN
FLY0Q86OtherBCBS