Provider Demographics
NPI:1891489746
Name:JOVIC, MARK A (RN)
Entity type:Individual
Prefix:MR
First Name:MARK
Middle Name:A
Last Name:JOVIC
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:90 SCHENCK AVE APT 3F
Mailing Address - Street 2:
Mailing Address - City:GREAT NECK
Mailing Address - State:NY
Mailing Address - Zip Code:11021-3653
Mailing Address - Country:US
Mailing Address - Phone:516-430-8408
Mailing Address - Fax:
Practice Address - Street 1:90 SCHENCK AVE APT 3F
Practice Address - Street 2:
Practice Address - City:GREAT NECK
Practice Address - State:NY
Practice Address - Zip Code:11021-3653
Practice Address - Country:US
Practice Address - Phone:516-430-8408
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-05
Last Update Date:2023-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY576524-01163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse