Basic Information
| Provider Information | |||||||||
| NPI: | 1366086233 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | NOWAK | ||||||||
| FirstName: | JASON | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3001 SW 24TH AVE APT 1814 | ||||||||
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| City: | OCALA | ||||||||
| State: | FL | ||||||||
| PostalCode: | 344717839 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 2221 SW 19TH AVENUE RD | ||||||||
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| City: | OCALA | ||||||||
| State: | FL | ||||||||
| PostalCode: | 344717757 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3526299100 | ||||||||
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| ProviderEnumerationDate: | 11/04/2019 | ||||||||
| LastUpdateDate: | 11/04/2019 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363AM0700X | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Medical |
No ID Information.