Provider Demographics
NPI:1407829666
Name:NOVAK, MARYANN (ARNP)
Entity Type:Individual
Prefix:MRS
First Name:MARYANN
Middle Name:
Last Name:NOVAK
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:840 S BEA AVE
Mailing Address - Street 2:
Mailing Address - City:INVERNESS
Mailing Address - State:FL
Mailing Address - Zip Code:34452-3603
Mailing Address - Country:US
Mailing Address - Phone:352-637-6300
Mailing Address - Fax:352-637-6487
Practice Address - Street 1:840 S BEA AVE
Practice Address - Street 2:
Practice Address - City:INVERNESS
Practice Address - State:FL
Practice Address - Zip Code:34452-3603
Practice Address - Country:US
Practice Address - Phone:352-637-6300
Practice Address - Fax:352-637-6487
Is Sole Proprietor?:No
Enumeration Date:2006-02-08
Last Update Date:2012-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP1606922363LP2300X, 364SF0001X, 363LX0001X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
No364SF0001XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistFamily Health
No363LX0001XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerObstetrics & Gynecology
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL034144400Medicaid
FL1407829666OtherTRICARE
FL230722OtherWELLCARE
FLS58418Medicare UPIN
FL230722OtherWELLCARE