MEDICARE: MARK A. NOWACKI MD PA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	305R00000X	Preferred Provider Organization	ME60591	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1427440213
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MARK A. NOWACKI MD PA

Provider Business Mailing Address
First Line	:	7011 1ST AVE S
Second Line	:
City	:	SAINT PETERSBURG
State	:	FL
Zip	:	33707-1203
Country	:	US
Telephone Number	:	727-347-4158
Fax Number	:	727-345-2260

Provider Business Practice Location Address
First Line	:	7011 1ST AVE S
Second Line	:
City	:	SAINT PETERSBURG
State	:	FL
Zip	:	33707-1203
Country	:	US
Telephone Number	:	727-347-4158
Fax Number	:	727-345-2260

Authorized Official
Title or Position	:	PHYSICIAN
Name	:	DR. MARK A NOWACKI
Credential	:	M.D
Telephone Number	:	727-347-4158

Provider Enumeration Date	:	03/03/2015
Last Update Date	:	04/04/2024

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