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Individual
DERICK NOWACKI
Active
Individual
DERICK NOWACKI
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
CRNP
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
SP032116
PA
261QU0200X
Urgent Care Clinic/Center
Primary
SP032116
PA
363LF0000X
Family Nurse Practitioner
SP032116
PA
Other
Enumeration date
02/06/2025
Last updated
05/22/2026
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