Healthcare Provider Details

I. General information

NPI: 1386916062
Provider Name (Legal Business Name): COMMUNITY MEDICAL ASSOCIATES, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/27/2012
Last Update Date: 01/27/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5176 WILLIAM SULLIVAN CIR
BROOKSVILLE FL
34604-8227
US

IV. Provider business mailing address

5176 WILLIAM SULLIVAN CIR
BROOKSVILLE FL
34604-8227
US

V. Phone/Fax

Practice location:
  • Phone: 352-593-0031
  • Fax:
Mailing address:
  • Phone: 352-593-0031
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberARNP912712
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberARNP3301752
License Number StateFL

VIII. Authorized Official

Name: MR. STEVEN EDWARD MALY
Title or Position: MANAGING MEMBER
Credential: ARNP
Phone: 352-593-0031