Provider Demographics
NPI:1487955241
Name:NOVAK, TERESA ANN (NP)
Entity type:Individual
Prefix:
First Name:TERESA
Middle Name:ANN
Last Name:NOVAK
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:601 S HARBOUR ISLAND BLVD STE 200
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33602-5925
Mailing Address - Country:US
Mailing Address - Phone:081-344-4583
Mailing Address - Fax:
Practice Address - Street 1:3257 CHATTANOOGA VALLEY RD
Practice Address - Street 2:
Practice Address - City:FLINTSTONE
Practice Address - State:GA
Practice Address - Zip Code:30725-2387
Practice Address - Country:US
Practice Address - Phone:706-841-7700
Practice Address - Fax:706-841-7800
Is Sole Proprietor?:No
Enumeration Date:2010-11-10
Last Update Date:2024-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN15316363LF0000X
GA123906363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1525310Medicaid