Provider Demographics
NPI:1144264920
Name:MCGOWAN, GENEVIEVE BLANCHARD (CRNA)
Entity type:Individual
Prefix:
First Name:GENEVIEVE
Middle Name:BLANCHARD
Last Name:MCGOWAN
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 323
Mailing Address - Street 2:
Mailing Address - City:PERRY
Mailing Address - State:FL
Mailing Address - Zip Code:32348-0323
Mailing Address - Country:US
Mailing Address - Phone:813-985-5992
Mailing Address - Fax:813-985-5982
Practice Address - Street 1:333 N BYRON BUTLER PKWY
Practice Address - Street 2:
Practice Address - City:PERRY
Practice Address - State:FL
Practice Address - Zip Code:32347-2300
Practice Address - Country:US
Practice Address - Phone:813-985-5992
Practice Address - Fax:813-985-5982
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP2878422367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLG2900OtherBCBS
FLG2900YMedicare ID - Type Unspecified
FLG2900OtherBCBS