NPIMap

Individual provider Active NPI

Marjorie Lewis Kovac, ARNP

  • Nurse Practitioner
  • Gulf Breeze, FL
National Provider Identifier
1740729144
Registry record updated Feb 17, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
License
2769302 Issued in FL
Practice address
4435 Gulf Breeze Pkwy
Gulf Breeze, FL 32563-9155
Phone
(850) 934-0064
NPI assigned
Feb 17, 2017
Last updated
Feb 17, 2017By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Feb 17, 2017

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Nurse Practitioner 363L00000X 2769302 FL Primary

Addresses

Primary practice location

4435 Gulf Breeze Pkwy
Gulf Breeze, FL 32563-9155

Mailing address

146 Brewer Cir
Mary Esther, FL 32569-2003
Phone (850) 830-8610

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20190102001465 FL Practitioner - Nurse Practitioner 6002151511 Reassigns benefits to 4 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2016
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Primary Care House Calls PAGroup PAC ID 8325263270, 14 clinicians

Practice addresses (Care Compare)

2744 Gulf Breeze Pkwy
Gulf Breeze, FL 32563-3091
Phone (850) 934-5713

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
2769302FLMDNurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Primary Care House Calls PA CurrentSince Nov 6, 2018 Accepting new patients

Locations

2744 Gulf Breeze Pkwy
Gulf Breeze, FL 32563
Phone (850) 313-9046

3416 Gulf Breeze Pkwy
Gulf Breeze, FL 32563
Phone (850) 565-9639

Interoperability endpoints

  • Direct secure messaging: marjorie.kovac.1@30358.direct.athenahealth.com

Organizations & group practices 4

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 9

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1487289600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1487289600000",
    "number": "1740729144",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "146 BREWER CIR",
            "city": "MARY ESTHER",
            "state": "FL",
            "postal_code": "325692003",
            "telephone_number": "850-830-8610"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4435 GULF BREEZE PKWY",
            "city": "GULF BREEZE",
            "state": "FL",
            "postal_code": "325639155",
            "telephone_number": "850-934-0064"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KOVAC",
        "first_name": "MARJORIE",
        "middle_name": "LEWIS",
        "name_prefix": "Ms.",
        "credential": "ARNP",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2017-02-17",
        "last_updated": "2017-02-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "FL",
            "license": "2769302",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Gulf Breeze, FL

Sources for this page

Verify at the official NPI Registry.