Provider Demographics
NPI:1528087830
Name:BOWMAN, SUSAN LYN (FNP-BC, APRN)
Entity type:Individual
Prefix:MRS
First Name:SUSAN
Middle Name:LYN
Last Name:BOWMAN
Suffix:
Gender:F
Credentials:FNP-BC, APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1150 SALIDO AVE
Mailing Address - Street 2:
Mailing Address - City:LADY LAKE
Mailing Address - State:FL
Mailing Address - Zip Code:32159
Mailing Address - Country:US
Mailing Address - Phone:715-610-7401
Mailing Address - Fax:844-395-8871
Practice Address - Street 1:1150 SALIDO AVE
Practice Address - Street 2:
Practice Address - City:LADY LAKE
Practice Address - State:FL
Practice Address - Zip Code:32159
Practice Address - Country:US
Practice Address - Phone:715-610-7401
Practice Address - Fax:844-395-8871
Is Sole Proprietor?:No
Enumeration Date:2006-07-18
Last Update Date:2021-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1473-33363LF0000X
FL11005456363LF0000X
WI1473363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI43898000Medicaid
WI1528087830Medicaid