Healthcare Provider Details

I. General information

NPI: 1043126410
Provider Name (Legal Business Name): MALISHA MAGLY ACNPC-AG
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/24/2026
Last Update Date: 08/24/2026
Certification Date: 08/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 SHIRCLIFF WAY
JACKSONVILLE FL
32204-4748
US

IV. Provider business mailing address

2500 INDIGO AVE
MIDDLEBURG FL
32068-6004
US

V. Phone/Fax

Practice location:
  • Phone: 512-730-3060
  • Fax:
Mailing address:
  • Phone: 912-400-1860
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License NumberAPRN11049776
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: