Provider Demographics
NPI:1063707933
Name:BOWSER, KOUJI J (CRNA)
Entity type:Individual
Prefix:
First Name:KOUJI
Middle Name:J
Last Name:BOWSER
Suffix:
Gender:
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2500 HARBOR BLVD
Mailing Address - Street 2:
Mailing Address - City:PORT CHARLOTTE
Mailing Address - State:FL
Mailing Address - Zip Code:33952-5000
Mailing Address - Country:US
Mailing Address - Phone:941-766-4125
Mailing Address - Fax:941-766-4101
Practice Address - Street 1:2500 HARBOR BLVD
Practice Address - Street 2:
Practice Address - City:PORT CHARLOTTE
Practice Address - State:FL
Practice Address - Zip Code:33952-5000
Practice Address - Country:US
Practice Address - Phone:941-766-4125
Practice Address - Fax:941-766-4101
Is Sole Proprietor?:No
Enumeration Date:2011-06-18
Last Update Date:2025-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN9228400367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLG00SGOtherBCBS
XXX-XX-5407OtherCHAMPUS / TRICARE SOUTH REGION
FL0038277 00Medicaid
XXX-XX-5407OtherCHAMPUS / TRICARE SOUTH REGION