Healthcare Provider Details

I. General information

NPI: 1144010554
Provider Name (Legal Business Name): DMITRIY P MASLIKOV APRN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/08/2025
Last Update Date: 05/08/2025
Certification Date: 05/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1329 SW 16TH ST STE 1210
GAINESVILLE FL
32608-1128
US

IV. Provider business mailing address

PO BOX 100371
GAINESVILLE FL
32610-0371
US

V. Phone/Fax

Practice location:
  • Phone: 352-265-0301
  • Fax:
Mailing address:
  • Phone: 352-265-0301
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License NumberAPRN11031519
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: