Provider Demographics
NPI:1841251600
Name:BOWSMAN, TRACEY HUSNANDER (RN, CDE)
Entity type:Individual
Prefix:
First Name:TRACEY
Middle Name:HUSNANDER
Last Name:BOWSMAN
Suffix:
Gender:F
Credentials:RN, CDE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4387 SW LA PALOMA DR
Mailing Address - Street 2:
Mailing Address - City:PALM CITY
Mailing Address - State:FL
Mailing Address - Zip Code:34990-7949
Mailing Address - Country:US
Mailing Address - Phone:772-287-7968
Mailing Address - Fax:
Practice Address - Street 1:3441 SE WILLOUGHBY BLVD
Practice Address - Street 2:
Practice Address - City:STUART
Practice Address - State:FL
Practice Address - Zip Code:34994-5060
Practice Address - Country:US
Practice Address - Phone:772-221-4030
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRN3191892163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse