Blake Andrew Nowicki, M.S., CCC-SLP

Primary specialty

Speech-Language PathologistTaxonomy code 235Z00000X

License

SA17719 Issued in FL

Practice address

4411 N Habana Ave
Tampa, FL 33614-7211

Phone

(813) 872-2771

NPI assigned

May 19, 2020

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Master of Science

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1589846400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1589846400000",
    "number": "1366065831",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4411 N HABANA AVE",
            "city": "TAMPA",
            "state": "FL",
            "postal_code": "336147211",
            "telephone_number": "813-872-2771"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4411 N HABANA AVE",
            "city": "TAMPA",
            "state": "FL",
            "postal_code": "336147211",
            "telephone_number": "813-872-2771"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NOWICKI",
        "first_name": "BLAKE",
        "middle_name": "ANDREW",
        "name_prefix": "Mr.",
        "credential": "M.S., CCC-SLP",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2020-05-19",
        "last_updated": "2020-05-19",
        "certification_date": "2020-05-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "FL",
            "license": "SA17719",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AMERICAN SPEECH-LANGUAGE-HEARING ASSOCIATION (ASHA)",
            "identifier": "14227109",
            "state": null
        }
    ],
    "endpoints": [
        {
            "endpointType": "OTHERS",
            "endpointTypeDescription": "Other URL",
            "endpoint": "bnowicki11@gmail.com",
            "affiliation": "N",
            "address_1": "2632 2nd Ct",
            "city": "Palm Harbor",
            "state": "FL",
            "country_code": "US",
            "postal_code": "346843809",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Novumhealth Medical Group FL
• Now and Zen Wellness LLC
• Suzanne Mary Nowak, MD
• Kristina Nowakowski
• Ethan Michael Nowell, MD
• Jordan Nowicki, APRN
• Taylor Marie Noyes
• NP Benise Gutierrez
• NP Infusion Center LLC
• NPR Anesthesia Services, LLC

• All providers in Tampa, FL
• Speech-Language Pathologist in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 19, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.