Healthcare Provider Details

I. General information

NPI: 1932960325
Provider Name (Legal Business Name): MALLORY HARVEY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/22/2024
Last Update Date: 05/04/2026
Certification Date: 05/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7547 JACQUE RD
HUDSON FL
34667-7163
US

IV. Provider business mailing address

7547 JACQUE RD
HUDSON FL
34667-7163
US

V. Phone/Fax

Practice location:
  • Phone: 727-862-8561
  • Fax: 727-863-7296
Mailing address:
  • Phone: 727-862-8561
  • Fax: 727-863-7296

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: