Provider Demographics
NPI:1285223420
Name:NOWAK, MILLICENT KATHLEEN (PA-C)
Entity Type:Individual
Prefix:
First Name:MILLICENT
Middle Name:KATHLEEN
Last Name:NOWAK
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 13834
Mailing Address - Street 2:
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32317-3834
Mailing Address - Country:US
Mailing Address - Phone:850-205-6232
Mailing Address - Fax:855-975-0615
Practice Address - Street 1:1704 RIGGINS RD
Practice Address - Street 2:
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32308-5318
Practice Address - Country:US
Practice Address - Phone:850-877-4134
Practice Address - Fax:850-942-4112
Is Sole Proprietor?:No
Enumeration Date:2021-01-12
Last Update Date:2023-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9113954363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant