Provider Demographics
NPI:1912797887
Name:NOVAK, GANNON JOHN
Entity type:Individual
Prefix:
First Name:GANNON
Middle Name:JOHN
Last Name:NOVAK
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7540 CITRUS BLOSSOM DR
Mailing Address - Street 2:
Mailing Address - City:LAND O LAKES
Mailing Address - State:FL
Mailing Address - Zip Code:34637-7468
Mailing Address - Country:US
Mailing Address - Phone:407-595-2579
Mailing Address - Fax:
Practice Address - Street 1:7540 CITRUS BLOSSOM DR
Practice Address - Street 2:
Practice Address - City:LAND O LAKES
Practice Address - State:FL
Practice Address - Zip Code:34637-7468
Practice Address - Country:US
Practice Address - Phone:407-595-2579
Practice Address - Fax:407-595-2579
Is Sole Proprietor?:No
Enumeration Date:2025-05-12
Last Update Date:2025-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst