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General NPI Number Information
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NPI Number | 1427440213
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Entity Type | Organization
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Legal Business Name | MARK A. NOWACKI MD PA
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Dates
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Enumeration Date | 03/03/2015
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Last Update Date | 04/04/2024
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Provider Practice Location Address
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Address Line | 7011 1ST AVE S
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City | SAINT PETERSBURG
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State | FL
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Zip | 33707-1203
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Country | US
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Telephone | 727-347-4158
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Fax | 727-345-2260
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Provider Business Mailing Address
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Address Line | 7011 1ST AVE S
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City | SAINT PETERSBURG
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State | FL
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Zip | 33707-1203
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Country | US
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Telephone | 727-347-4158
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Fax | 727-345-2260
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Authorized Official
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Title or Position | PHYSICIAN
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Name | DR. MARK A NOWACKI
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Credential | M.D
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Telephone | 727-347-4158
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 305R00000X
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Taxonomy Name | Preferred Provider Organization
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License Number | ME60591
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License Number State | FL
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