Bring a large pot of salted water to a boil. Cook pasta until al dente according to package directions. Reserve 1/2 cup pasta water before draining.
Pat chicken dry with paper towels. Season with Italian seasoning, paprika, garlic powder, onion powder, salt, and black pepper.
Heat olive oil in a large skillet over medium-high heat. Add chicken in a single layer, cooking in batches if needed. Cook for 5 to 7 minutes, stirring occasionally, until golden brown and cooked through to 165°F. Transfer chicken to a plate.
Reduce heat to medium. Add butter and garlic to the same skillet. Cook for about 30 seconds, stirring constantly, until fragrant.
Pour in chicken broth and scrape up the browned bits from the bottom of the skillet. Simmer for 1 to 2 minutes.
Reduce heat to medium-low. Add heavy cream and cream cheese. Stir until the cream cheese melts smoothly into the sauce.
Remove the skillet from the heat. Add Parmesan cheese a little at a time, stirring until the sauce is smooth and creamy.
Add the cooked pasta, chicken, and 1/4 cup reserved pasta water. Toss until evenly coated.
Add spinach, nutmeg if using, and red pepper flakes if using. Toss until the spinach is just wilted.
Add more pasta water, 1 tablespoon at a time, until the sauce is glossy and coats the pasta.
Place the skillet over low heat for 1 minute only if the pasta needs warming. Do not boil after adding the Parmesan.
Stir in 1 teaspoon lemon juice. Taste and add more lemon juice, salt, black pepper, Parmesan, or red pepper flakes as needed.
Serve warm with extra Parmesan on top.