Susan Lyn Bowman, FNP-BC, APRN

Primary specialty

Nurse PractitionerTaxonomy code 363L00000X

License

1473 Issued in WI

Practice address

1150 Salido Ave
Lady Lake, FL 32159

Phone

(715) 610-7401

Fax

(844) 395-8871

NPI assigned

Jul 18, 2006

Last updated

Oct 15, 2021By the provider in NPPES

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 3

Addresses

Medicare fee-for-service enrollment

Enrolled in WI

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1153180800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1634256000000",
    "number": "1528087830",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1150 SALIDO AVE",
            "city": "LADY LAKE",
            "state": "FL",
            "postal_code": "32159",
            "telephone_number": "715-610-7401",
            "fax_number": "844-395-8871"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1150 SALIDO AVE",
            "city": "LADY LAKE",
            "state": "FL",
            "postal_code": "32159",
            "telephone_number": "715-610-7401",
            "fax_number": "844-395-8871"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BOWMAN",
        "first_name": "SUSAN",
        "middle_name": "LYN",
        "name_prefix": "Mrs.",
        "credential": "FNP-BC, APRN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-07-18",
        "last_updated": "2021-10-15",
        "certification_date": "2021-10-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "WI",
            "license": "1473-33",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "FL",
            "license": "11005456",
            "primary": false
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "WI",
            "license": "1473",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Bladder Institute of Florida LLC (Vascular and Renal Care of Florida)
• Bladder Institute of Florida LLC (Vascular and Renal Care of Florida)
• Mica Collins Booth
• Keith L Bostaph, DC
• Kenneth Lee Bowman, MD
• Luther Quitoriano Braganza, PT
• Dianna Bridges, NP
• Tara Lynne Briggs
• Darrin Brooks
• Keri Kristin Brooks, RPT

• Nurse Practitioner in Lady Lake, FL
• Providers in Lady Lake, FL by specialty
• Nurse Practitioner in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 15, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.