Healthcare Provider Details

I. General information

NPI: 1407319718
Provider Name (Legal Business Name): NATALIE NICOLE NOWICKI DPM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/12/2019
Last Update Date: 12/06/2025
Certification Date: 12/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5405 OKEECHOBEE BLVD
WEST PALM BEACH FL
33417-4543
US

IV. Provider business mailing address

419 SE 2ND ST APT 1720
FORT LAUDERDALE FL
33301-4477
US

V. Phone/Fax

Practice location:
  • Phone: 561-293-3439
  • Fax: 561-689-1844
Mailing address:
  • Phone: 754-304-5091
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License NumberPO4407
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: