Provider Demographics
NPI:1114331097
Name:NOVICK, REBECCA FRIEDMAN (NP)
Entity Type:Individual
Prefix:MS
First Name:REBECCA
Middle Name:FRIEDMAN
Last Name:NOVICK
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:6100 PRIMACY PKWY STE 112
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38119-0705
Mailing Address - Country:US
Mailing Address - Phone:901-682-5335
Mailing Address - Fax:901-682-5440
Practice Address - Street 1:6100 PRIMACY PKWY STE 112
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38119-0705
Practice Address - Country:US
Practice Address - Phone:901-682-5335
Practice Address - Fax:901-682-5440
Is Sole Proprietor?:No
Enumeration Date:2014-06-18
Last Update Date:2023-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN50576163W00000X
TN30902363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No163W00000XNursing Service ProvidersRegistered Nurse