Basic Information
| Provider Information | |||||||||
| NPI: | 1326378035 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | NOWAK | ||||||||
| FirstName: | TINA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 501 S BROAD ST | ||||||||
| Address2: | |||||||||
| City: | BREVARD | ||||||||
| State: | NC | ||||||||
| PostalCode: | 287124044 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8282780563 | ||||||||
| FaxNumber: | 8288842187 | ||||||||
| Practice Location | |||||||||
| Address1: | 501 S BROAD ST | ||||||||
| Address2: | |||||||||
| City: | BREVARD | ||||||||
| State: | NC | ||||||||
| PostalCode: | 287124044 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8282780563 | ||||||||
| FaxNumber: | 8288842187 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/31/2009 | ||||||||
| LastUpdateDate: | 12/31/2009 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163WP0808X | 166540 | NC | Y | Nursing Service Providers | Registered Nurse | Psych/Mental Health |
No ID Information.