Provider Demographics
NPI:1154674125
Name:NOWAK, MICHELLE D (NP)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:D
Last Name:NOWAK
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:MICHELLE
Other - Middle Name:D
Other - Last Name:IREY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2675 WINKLER AVE FL 2
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33901-9342
Mailing Address - Country:US
Mailing Address - Phone:877-856-3774
Mailing Address - Fax:239-599-2612
Practice Address - Street 1:6610 WILLOW PARK DR STE 101
Practice Address - Street 2:
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34109-9014
Practice Address - Country:US
Practice Address - Phone:239-649-3307
Practice Address - Fax:239-254-1782
Is Sole Proprietor?:No
Enumeration Date:2012-10-16
Last Update Date:2022-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN9384792363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL013515700Medicaid
FLY0NS6OtherFLORIDA BLUE
FL013515700Medicaid