Basic Information
| Provider Information | |||||||||
| NPI: | 1851807259 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | JOWERS | ||||||||
| FirstName: | ALICIA | ||||||||
| MiddleName: | D | ||||||||
| NamePrefix: | MRS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | ARNP, CNM | ||||||||
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| Mailing Information | |||||||||
| Address1: | 300 HEALTH PARK BLVD STE 3002 | ||||||||
| Address2: | |||||||||
| City: | SAINT AUGUSTINE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 320863703 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9048191500 | ||||||||
| FaxNumber: | 9048101023 | ||||||||
| Practice Location | |||||||||
| Address1: | 300 HEALTH PARK BLVD STE 3002 | ||||||||
| Address2: | |||||||||
| City: | SAINT AUGUSTINE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 320863703 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9048191500 | ||||||||
| FaxNumber: | 9048101023 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/20/2017 | ||||||||
| LastUpdateDate: | 12/11/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 12/11/2019 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 367A00000X | APRN9273208 | FL | Y | Physician Assistants & Advanced Practice Nursing Providers | Advanced Practice Midwife |
ID Information
| ID | Type | State | Issuer | Description | 024123100 | 05 | FL | MEDICAID |