Provider Demographics
NPI:1699576934
Name:FOWLER, MAURA (RDN)
Entity type:Individual
Prefix:MS
First Name:MAURA
Middle Name:
Last Name:FOWLER
Suffix:
Gender:
Credentials:RDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9522 CITRUS GLEN PL
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33618-4018
Mailing Address - Country:US
Mailing Address - Phone:818-321-5841
Mailing Address - Fax:
Practice Address - Street 1:9522 CITRUS GLEN PL
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33618-4018
Practice Address - Country:US
Practice Address - Phone:818-321-5841
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-22
Last Update Date:2025-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL14068133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered