Provider Demographics
NPI:1760364517
Name:NOVAK, BETTINA ANEMARIE (AGACNP)
Entity type:Individual
Prefix:
First Name:BETTINA
Middle Name:ANEMARIE
Last Name:NOVAK
Suffix:
Gender:F
Credentials:AGACNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2360 AUGUSTINE DR
Mailing Address - Street 2:
Mailing Address - City:PARMA
Mailing Address - State:OH
Mailing Address - Zip Code:44134-4756
Mailing Address - Country:US
Mailing Address - Phone:440-212-3751
Mailing Address - Fax:
Practice Address - Street 1:2360 AUGUSTINE DR
Practice Address - Street 2:
Practice Address - City:PARMA
Practice Address - State:OH
Practice Address - Zip Code:44134-4756
Practice Address - Country:US
Practice Address - Phone:440-212-3751
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-07-23
Last Update Date:2025-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAPRN.CNP.0039759363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care