Individual
ETHAN MICHAEL NOWELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
5 TAMPA GENERAL CIR # 750, TAMPA, FL 33606-3601
(813) 844-3397
Mailing address
PO BOX 917770, ORLANDO, FL 32891-0001
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
ME162905
FL
208000000X
Pediatrics Physician
ME162905
FL
208M00000X
Hospitalist Physician
Primary
ME162905
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
121315700
—
FL
01
—
9N6GU
BLUE CROSS BLUE SHIELD
FL
Enumeration date
03/26/2019
Last updated
04/17/2024
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