Provider Demographics
NPI:1780677559
Name:NOVAK, YVETTE (MD)
Entity Type:Individual
Prefix:MRS
First Name:YVETTE
Middle Name:
Last Name:NOVAK
Suffix:
Gender:F
Credentials:MD
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 907
Mailing Address - Street 2:
Mailing Address - City:DESTIN
Mailing Address - State:FL
Mailing Address - Zip Code:32541-0907
Mailing Address - Country:US
Mailing Address - Phone:850-837-0141
Mailing Address - Fax:850-837-8801
Practice Address - Street 1:994 AIRPORT RD
Practice Address - Street 2:
Practice Address - City:DESTIN
Practice Address - State:FL
Practice Address - Zip Code:32541-2820
Practice Address - Country:US
Practice Address - Phone:850-837-0141
Practice Address - Fax:850-837-8801
Is Sole Proprietor?:No
Enumeration Date:2005-08-26
Last Update Date:2012-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME47513207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL46191OtherBCBS
FL46191OtherBCBS
46191Medicare ID - Type Unspecified