Provider Demographics
NPI:1831746056
Name:BOWMAN, TONIA MICHELLE
Entity type:Individual
Prefix:
First Name:TONIA
Middle Name:MICHELLE
Last Name:BOWMAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1608 SPRING LAKE RD
Mailing Address - Street 2:
Mailing Address - City:FRUITLAND PARK
Mailing Address - State:FL
Mailing Address - Zip Code:34731-5238
Mailing Address - Country:US
Mailing Address - Phone:352-805-3031
Mailing Address - Fax:
Practice Address - Street 1:1608 SPRING LAKE RD
Practice Address - Street 2:
Practice Address - City:FRUITLAND PARK
Practice Address - State:FL
Practice Address - Zip Code:34731-5238
Practice Address - Country:US
Practice Address - Phone:352-805-3031
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-22
Last Update Date:2019-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health