Healthcare Provider Details

I. General information

NPI: 1598375743
Provider Name (Legal Business Name): LESLIE NOVAKOVIC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/03/2020
Last Update Date: 08/28/2023
Certification Date: 08/28/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6700 NW 10TH PL
GAINESVILLE FL
32605-4213
US

IV. Provider business mailing address

1559 N RIDGE MEADOW PATH
HERNANDO FL
34442-6324
US

V. Phone/Fax

Practice location:
  • Phone: 352-331-3111
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberSA19207
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: