Provider Demographics
NPI:1639904378
Name:NOVAK, DEBRA ANN (RN, IBCLC)
Entity type:Individual
Prefix:
First Name:DEBRA
Middle Name:ANN
Last Name:NOVAK
Suffix:
Gender:F
Credentials:RN, IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10950 SAN JOSE BLVD STE 60
Mailing Address - Street 2:PMB 263
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32223-6671
Mailing Address - Country:US
Mailing Address - Phone:904-509-7013
Mailing Address - Fax:
Practice Address - Street 1:1621 W CARROLL AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60612-2501
Practice Address - Country:US
Practice Address - Phone:888-510-0059
Practice Address - Fax:708-406-1629
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-03
Last Update Date:2024-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLL-109466163WL0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant