Provider Demographics
NPI:1043309610
Name:NOWAKOWSKA, BEATA B (MD)
Entity Type:Individual
Prefix:DR
First Name:BEATA
Middle Name:B
Last Name:NOWAKOWSKA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:BEATA
Other - Middle Name:B
Other - Last Name:NOWAKOWSKA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:2568 SWEETGUM WAY W
Mailing Address - Street 2:
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33761-3922
Mailing Address - Country:US
Mailing Address - Phone:727-735-5356
Mailing Address - Fax:
Practice Address - Street 1:1301 2ND AVE SW
Practice Address - Street 2:
Practice Address - City:LARGO
Practice Address - State:FL
Practice Address - Zip Code:33770-3120
Practice Address - Country:US
Practice Address - Phone:727-581-8767
Practice Address - Fax:727-559-0594
Is Sole Proprietor?:No
Enumeration Date:2006-10-12
Last Update Date:2017-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1554552085R0202X
FLME807572085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL263859200Medicaid