Provider Demographics
NPI:1124580451
Name:MOWATT, TANIA (APRN)
Entity type:Individual
Prefix:
First Name:TANIA
Middle Name:
Last Name:MOWATT
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:32845 RADIO RD
Mailing Address - Street 2:
Mailing Address - City:LEESBURG
Mailing Address - State:FL
Mailing Address - Zip Code:34788-3977
Mailing Address - Country:US
Mailing Address - Phone:352-504-3453
Mailing Address - Fax:
Practice Address - Street 1:2353 OCOEE APOPKA RD
Practice Address - Street 2:
Practice Address - City:OCOEE
Practice Address - State:FL
Practice Address - Zip Code:34761-5301
Practice Address - Country:US
Practice Address - Phone:407-756-5393
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-04-04
Last Update Date:2023-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9218188363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily