Provider Demographics
NPI:1821801903
Name:NOVAK, ALEXIS TAYLOR (CRNP)
Entity type:Individual
Prefix:
First Name:ALEXIS
Middle Name:TAYLOR
Last Name:NOVAK
Suffix:
Gender:
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2076 WILLIAM PENN AVE
Mailing Address - Street 2:
Mailing Address - City:JOHNSTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:15909-1450
Mailing Address - Country:US
Mailing Address - Phone:814-270-5677
Mailing Address - Fax:
Practice Address - Street 1:350 BUDFIELD ST STE B
Practice Address - Street 2:
Practice Address - City:JOHNSTOWN
Practice Address - State:PA
Practice Address - Zip Code:15904-3280
Practice Address - Country:US
Practice Address - Phone:814-266-9919
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-01-31
Last Update Date:2025-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP029875363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily