Provider Demographics
NPI:1316473697
Name:NOVAKOVICH, RENEE (FNP-C)
Entity type:Individual
Prefix:
First Name:RENEE
Middle Name:
Last Name:NOVAKOVICH
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:704 ADOBE DR
Mailing Address - Street 2:
Mailing Address - City:SANTA ROSA
Mailing Address - State:CA
Mailing Address - Zip Code:95404-2706
Mailing Address - Country:US
Mailing Address - Phone:707-293-0136
Mailing Address - Fax:
Practice Address - Street 1:704 ADOBE DR
Practice Address - Street 2:
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95404-2706
Practice Address - Country:US
Practice Address - Phone:707-293-0136
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-05-05
Last Update Date:2017-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA512827363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
CANPF 95004969OtherNURSING FURNISHING NUMBER
CANP 95004969OtherNURSE PRACTITIONER CERTIFICATE