Healthcare Provider Details

I. General information

NPI: 1780837708
Provider Name (Legal Business Name): JAMIE DANIEL NOVAK CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/04/2008
Last Update Date: 09/11/2024
Certification Date: 09/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4725 N FEDERAL HWY
FT LAUDERDALE FL
33308-4603
US

IV. Provider business mailing address

PO BOX 80690
CANTON OH
44708-0690
US

V. Phone/Fax

Practice location:
  • Phone: 954-771-8000
  • Fax: 954-351-4727
Mailing address:
  • Phone: 330-833-5530
  • Fax: 330-833-6085

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberCOA10359NA
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: