Provider Demographics
NPI:1881792976
Name:ROWE, SUE ELLEN (PA)
Entity type:Individual
Prefix:MS
First Name:SUE
Middle Name:ELLEN
Last Name:ROWE
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:11373 CORTEZ BLVD STE 202
Mailing Address - Street 2:
Mailing Address - City:BROOKSVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:34613-5405
Mailing Address - Country:US
Mailing Address - Phone:352-597-3444
Mailing Address - Fax:352-597-0117
Practice Address - Street 1:11373 CORTEZ BLVD STE 202
Practice Address - Street 2:
Practice Address - City:BROOKSVILLE
Practice Address - State:FL
Practice Address - Zip Code:34613-5405
Practice Address - Country:US
Practice Address - Phone:352-597-3444
Practice Address - Fax:352-597-0117
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2021-06-03
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PAMA001202L363AM0700X, 363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY000927001002OtherHEATH NOW