Healthcare Provider Details

I. General information

NPI: 1952357170
Provider Name (Legal Business Name): JOHN RICHARD NOVIELLO CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/26/2006
Last Update Date: 05/09/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2815 S SEACREST BLVD
BOYNTON BEACH FL
33435-7934
US

IV. Provider business mailing address

517 38TH ST
WEST PALM BEACH FL
33407-4101
US

V. Phone/Fax

Practice location:
  • Phone: 561-737-7733
  • Fax:
Mailing address:
  • Phone: 561-863-8721
  • Fax: 561-863-8721

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367H00000X
TaxonomyAnesthesiologist Assistant
License NumberARNP9167947
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: