Provider Demographics
NPI:1174621429
Name:BOWEN, LEAH ANNETTE (ARNP-BC)
Entity type:Individual
Prefix:
First Name:LEAH
Middle Name:ANNETTE
Last Name:BOWEN
Suffix:
Gender:F
Credentials:ARNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30 DEL PRADO BLVD N
Mailing Address - Street 2:
Mailing Address - City:CAPE CORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33909-2705
Mailing Address - Country:US
Mailing Address - Phone:239-829-0099
Mailing Address - Fax:
Practice Address - Street 1:30 DEL PRADO BLVD N STE 100
Practice Address - Street 2:
Practice Address - City:CAPE CORAL
Practice Address - State:FL
Practice Address - Zip Code:33909-2734
Practice Address - Country:US
Practice Address - Phone:239-829-0099
Practice Address - Fax:239-673-9694
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2018-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP1840312363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLS71306Medicare UPIN
FLAV026ZMedicare PIN