Provider Demographics
NPI:1326378035
Name:NOWAK, TINA
Entity Type:Individual
Prefix:
First Name:TINA
Middle Name:
Last Name:NOWAK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:501 S BROAD ST
Mailing Address - Street 2:
Mailing Address - City:BREVARD
Mailing Address - State:NC
Mailing Address - Zip Code:28712-4044
Mailing Address - Country:US
Mailing Address - Phone:828-278-0563
Mailing Address - Fax:828-884-2187
Practice Address - Street 1:501 S BROAD ST
Practice Address - Street 2:
Practice Address - City:BREVARD
Practice Address - State:NC
Practice Address - Zip Code:28712-4044
Practice Address - Country:US
Practice Address - Phone:828-278-0563
Practice Address - Fax:828-884-2187
Is Sole Proprietor?:No
Enumeration Date:2009-12-31
Last Update Date:2009-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC166540163WP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health