Provider Demographics
NPI:1932249778
Name:NOVAK, GINA L (CRNP)
Entity Type:Individual
Prefix:MRS
First Name:GINA
Middle Name:L
Last Name:NOVAK
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:409 N CAROLINE ST
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21231-1003
Mailing Address - Country:US
Mailing Address - Phone:410-614-6189
Mailing Address - Fax:410-955-0729
Practice Address - Street 1:409 N CAROLINE ST
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21231-1003
Practice Address - Country:US
Practice Address - Phone:410-614-6189
Practice Address - Fax:410-955-0729
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-08
Last Update Date:2010-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDRO91467363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD027536100Medicaid
MDRO91467OtherLICENSE
MD027536100Medicaid