1205003456 NPI number — ERIN LEIGH NOVO AUD

Table of content: ERIN LEIGH NOVO AUD (NPI 1205003456)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1205003456 NPI number — ERIN LEIGH NOVO AUD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
NOVO
Provider First Name:
ERIN
Provider Middle Name:
LEIGH
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
AUD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
CAMPBELL
Provider Other First Name:
ERIN
Provider Other Middle Name:
LEIGH
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
AUD
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1205003456
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/02/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
410 CELEBRATION PL
Provider Second Line Business Mailing Address:
SUITE 100
Provider Business Mailing Address City Name:
CELEBRATION
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
34747-5433
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
321-939-3000
Provider Business Mailing Address Fax Number:
321-939-3001

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
410 CELEBRATION PL
Provider Second Line Business Practice Location Address:
SUITE 100
Provider Business Practice Location Address City Name:
CELEBRATION
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
34747-5433
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
321-939-3000
Provider Business Practice Location Address Fax Number:
321-939-3001
Provider Enumeration Date:
05/15/2008

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 231H00000X , with the licence number:  AY1420 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)