Healthcare Provider Details

I. General information

NPI: 1316870314
Provider Name (Legal Business Name): MARCO MALASPINA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/08/2026
Last Update Date: 06/08/2026
Certification Date: 06/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13121 ATLANTIC BLVD STE 200
JACKSONVILLE FL
32225-0102
US

IV. Provider business mailing address

14051 BEACH BLVD
JACKSONVILLE BEACH FL
32250-1507
US

V. Phone/Fax

Practice location:
  • Phone: 190-449-1211
  • Fax:
Mailing address:
  • Phone: 908-442-2155
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: