Healthcare Provider Details

I. General information

NPI: 1871055350
Provider Name (Legal Business Name): MALIA S GAVIGAN APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MALIA S FLORES

II. Dates (important events)

Enumeration Date: 04/03/2019
Last Update Date: 12/17/2025
Certification Date: 12/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

701 W COCOA BEACH CSWY
COCOA BEACH FL
32931-3585
US

IV. Provider business mailing address

3300 S FISKE BLVD
ROCKLEDGE FL
32955-4306
US

V. Phone/Fax

Practice location:
  • Phone: 321-868-5871
  • Fax: 321-868-5852
Mailing address:
  • Phone: 321-549-0573
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License NumberAPRN11001047
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberAPRN11001047
License Number StateFL
# 3
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAPRN11001047
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: