Provider Demographics
NPI:1104833524
Name:GIOVANINI, MARK A (MD)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:A
Last Name:GIOVANINI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9400 UNIVERSITY PKWY STE 309
Mailing Address - Street 2:
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32514-5485
Mailing Address - Country:US
Mailing Address - Phone:850-934-7545
Mailing Address - Fax:850-934-7972
Practice Address - Street 1:9400 UNIVERSITY PKWY STE 309
Practice Address - Street 2:
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32514-5485
Practice Address - Country:US
Practice Address - Phone:850-934-7545
Practice Address - Fax:850-934-7972
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-01
Last Update Date:2019-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0064731207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL259917100Medicaid
FLG93586Medicare UPIN
FL46345Medicare ID - Type Unspecified