Provider Demographics
NPI:1639931629
Name:STEVANOVSKI, NICOLETTE LINEA (PA-C)
Entity Type:Individual
Prefix:
First Name:NICOLETTE
Middle Name:LINEA
Last Name:STEVANOVSKI
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 1:2827 MABLE COUCH WAY
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37931-4284
Mailing Address - Country:US
Mailing Address - Phone:248-860-5913
Mailing Address - Fax:
Practice Address - Street 1:2827 MABLE COUCH WAY
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37931-4284
Practice Address - Country:US
Practice Address - Phone:248-860-5913
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-25
Last Update Date:2024-01-25
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant