Provider Demographics
NPI:1922205467
Name:NOWAKOWSKI, TARA (RPA-C)
Entity Type:Individual
Prefix:
First Name:TARA
Middle Name:
Last Name:NOWAKOWSKI
Suffix:
Gender:F
Credentials:RPA-C
Other - Prefix:
Other - First Name:TARA
Other - Middle Name:
Other - Last Name:NOWAKOWSKI
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PA
Mailing Address - Street 1:1101 STEWART AVE
Mailing Address - Street 2:
Mailing Address - City:GARDEN CITY
Mailing Address - State:NY
Mailing Address - Zip Code:11530-4892
Mailing Address - Country:US
Mailing Address - Phone:516-302-8180
Mailing Address - Fax:516-992-4637
Practice Address - Street 1:36 LINCOLN AVE
Practice Address - Street 2:
Practice Address - City:ROCKVILLE CENTRE
Practice Address - State:NY
Practice Address - Zip Code:11570-5768
Practice Address - Country:US
Practice Address - Phone:516-536-2800
Practice Address - Fax:516-705-4038
Is Sole Proprietor?:No
Enumeration Date:2007-06-28
Last Update Date:2018-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY011523363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical