Provider Demographics
NPI:1992171359
Name:BOWENS, NYIA (BSW)
Entity type:Individual
Prefix:
First Name:NYIA
Middle Name:
Last Name:BOWENS
Suffix:
Gender:F
Credentials:BSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:981 WILLOW CREEK LN
Mailing Address - Street 2:
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32301-7320
Mailing Address - Country:US
Mailing Address - Phone:305-479-1759
Mailing Address - Fax:850-331-6489
Practice Address - Street 1:981 WILLOW CREEK LN
Practice Address - Street 2:
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32301-7320
Practice Address - Country:US
Practice Address - Phone:305-479-1759
Practice Address - Fax:850-331-6489
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-19
Last Update Date:2020-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
104100000X
FL165831041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker