Healthcare Provider Details

I. General information

NPI: 1194631143
Provider Name (Legal Business Name): MICHAEL NOVA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/20/2026
Last Update Date: 08/20/2026
Certification Date: 08/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7184 SW 22ND PL
DAVIE FL
33317-7118
US

IV. Provider business mailing address

7184 SW 22ND PL
DAVIE FL
33317-7118
US

V. Phone/Fax

Practice location:
  • Phone: 786-539-6990
  • Fax:
Mailing address:
  • Phone: 786-539-6990
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code311ZA0620X
TaxonomyAdult Care Home Facility
License Number
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: