Provider Demographics
NPI:1740729144
Name:KOVAC, MARJORIE LEWIS (ARNP)
Entity type:Individual
Prefix:MS
First Name:MARJORIE
Middle Name:LEWIS
Last Name:KOVAC
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 1:146 BREWER CIR
Mailing Address - Street 2:
Mailing Address - City:MARY ESTHER
Mailing Address - State:FL
Mailing Address - Zip Code:32569-2003
Mailing Address - Country:US
Mailing Address - Phone:850-830-8610
Mailing Address - Fax:
Practice Address - Street 1:4435 GULF BREEZE PKWY
Practice Address - Street 2:
Practice Address - City:GULF BREEZE
Practice Address - State:FL
Practice Address - Zip Code:32563-9155
Practice Address - Country:US
Practice Address - Phone:850-934-0064
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-02-17
Last Update Date:2017-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL2769302363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner