Provider Demographics
NPI:1366154122
Name:BOWLES, BIANCA SHANELL (FNP-C)
Entity type:Individual
Prefix:
First Name:BIANCA
Middle Name:SHANELL
Last Name:BOWLES
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1940 E WILCOX ST
Mailing Address - Street 2:SUITE 102
Mailing Address - City:SIERRA VISTA
Mailing Address - State:AZ
Mailing Address - Zip Code:85635-4783
Mailing Address - Country:US
Mailing Address - Phone:520-335-2400
Mailing Address - Fax:
Practice Address - Street 1:1940 E WILCOX ST
Practice Address - Street 2:STE 102
Practice Address - City:SIERRA VISTA
Practice Address - State:AZ
Practice Address - Zip Code:85635
Practice Address - Country:US
Practice Address - Phone:520-335-2400
Practice Address - Fax:877-669-0381
Is Sole Proprietor?:No
Enumeration Date:2022-12-22
Last Update Date:2023-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ285236363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily