Provider Demographics
NPI:1346410263
Name:ALFREDO NOVA PA
Entity Type:Organization
Organization Name:ALFREDO NOVA PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ALFREDO
Authorized Official - Middle Name:
Authorized Official - Last Name:NOVA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:850-942-7750
Mailing Address - Street 1:1405 CENTERVILLE ROAD SUITE 4000
Mailing Address - Street 2:
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32308-4648
Mailing Address - Country:US
Mailing Address - Phone:850-942-7414
Mailing Address - Fax:
Practice Address - Street 1:1405 CENTERVILLE RD STE 4000
Practice Address - Street 2:
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32308-4648
Practice Address - Country:US
Practice Address - Phone:850-942-7414
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-06
Last Update Date:2008-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME-84728207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty