Susan Lyn Bowman, FNP-BC, APRN
Individual provider Active NPI Nurse Practitioner · Lady Lake, FL
NPI 1528087830 · NPPES record last updated Oct 15, 2021
Key facts
- NPI
- 1528087830
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Nurse Practitioner 363L00000X
- License
- 1473 (WI)
- Practice address
- 1150 Salido Ave
Lady Lake, FL 32159 - Phone
- (715) 610-7401
- Fax
- (844) 395-8871
- NPI assigned
- Jul 18, 2006
- Sex
- Female
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in WI
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20180919002268 | WI | Order and Referring Only - Nurse Practitioner | 2062421118 |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1473 | WI | MD | Nurse Practitioner |
| 11005456 | FL | MD | Family Nurse Practitioner |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Nurse Practitioner | 363LF0000X | 1473-33 | WI | |
| Family Nurse Practitioner | 363LF0000X | 11005456 | FL | |
| Nurse Practitioner | 363L00000X | 1473 | WI | Yes |
Addresses
Primary practice location
1150 Salido Ave
Lady Lake, FL 32159
Mailing address
1150 Salido Ave
Lady Lake, FL 32159
Phone (715) 610-7401
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 43898000 | Medicaid | WI | |
| 1528087830 | Medicaid | WI |
Other providers in Lady Lake, FL
- Bladder Institute of Florida LLC
- Bladder Institute of Florida LLC
- Mica Collins Booth
- Keith L Bostaph
- Kenneth Lee Bowman
- Luther Quitoriano Braganza
- Dianna Bridges
- Tara Lynne Briggs
- Keri Kristin Brooks
- Jenna Elizabeth Brown
All providers in Lady Lake, FL · Nurse Practitioner in Florida
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Oct 15, 2021. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.