Provider Demographics
NPI:1699957936
Name:BOWKUS, MARGARITA
Entity type:Individual
Prefix:MRS
First Name:MARGARITA
Middle Name:
Last Name:BOWKUS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 SILVER BEACH AVE
Mailing Address - Street 2:UNIT 128
Mailing Address - City:DAYTONA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32118-7108
Mailing Address - Country:US
Mailing Address - Phone:386-868-3596
Mailing Address - Fax:386-868-3596
Practice Address - Street 1:100 SILVER BEACH AVE
Practice Address - Street 2:UNIT 128
Practice Address - City:DAYTONA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32118-7108
Practice Address - Country:US
Practice Address - Phone:386-868-3596
Practice Address - Fax:386-868-3596
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-28
Last Update Date:2007-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker