Provider Demographics
NPI:1982980645
Name:NOVAR, LISSETTE (PA-C)
Entity Type:Individual
Prefix:
First Name:LISSETTE
Middle Name:
Last Name:NOVAR
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:105 NE 3RD ST
Mailing Address - Street 2:
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33301-1046
Mailing Address - Country:US
Mailing Address - Phone:754-206-2420
Mailing Address - Fax:954-867-5583
Practice Address - Street 1:105 NE 3RD ST
Practice Address - Street 2:
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33301
Practice Address - Country:US
Practice Address - Phone:754-206-2420
Practice Address - Fax:954-867-5583
Is Sole Proprietor?:No
Enumeration Date:2011-10-26
Last Update Date:2018-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA21236363AM0700X
FL9105101363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical