Provider Demographics
NPI:1083698476
Name:GREEN, NOVETTE SANDRA (ARNP)
Entity Type:Individual
Prefix:MRS
First Name:NOVETTE
Middle Name:SANDRA
Last Name:GREEN
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:12959 PALMS WEST DR
Mailing Address - Street 2:SUITE 120
Mailing Address - City:LOXAHATCHEE
Mailing Address - State:FL
Mailing Address - Zip Code:33470-4937
Mailing Address - Country:US
Mailing Address - Phone:561-753-8888
Mailing Address - Fax:561-795-5004
Practice Address - Street 1:12959 PALMS WEST DR
Practice Address - Street 2:SUITE 120
Practice Address - City:LOXAHATCHEE
Practice Address - State:FL
Practice Address - Zip Code:33470-4937
Practice Address - Country:US
Practice Address - Phone:561-753-8888
Practice Address - Fax:561-795-5004
Is Sole Proprietor?:No
Enumeration Date:2005-11-30
Last Update Date:2017-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9230252363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL307104900Medicaid
FL017283300Medicaid