Provider Demographics
NPI:1750742680
Name:BOWMAN, SARA (LPN)
Entity type:Individual
Prefix:
First Name:SARA
Middle Name:
Last Name:BOWMAN
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 16011
Mailing Address - Street 2:
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33766-6011
Mailing Address - Country:US
Mailing Address - Phone:727-307-0345
Mailing Address - Fax:727-674-2932
Practice Address - Street 1:4374 RIDGEMOOR DR
Practice Address - Street 2:
Practice Address - City:PALM HARBOR
Practice Address - State:FL
Practice Address - Zip Code:34685-1165
Practice Address - Country:US
Practice Address - Phone:727-831-8395
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-21
Last Update Date:2016-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL5211408251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health