Healthcare Provider Details

I. General information

NPI: 1821312745
Provider Name (Legal Business Name): DENISE MALIA LOCK COMPANION APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: DENISE MALIA LOCK N.P.

II. Dates (important events)

Enumeration Date: 03/22/2010
Last Update Date: 03/23/2023
Certification Date: 03/23/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 CELEBRATION PL
KISSIMMEE FL
34747-4970
US

IV. Provider business mailing address

10140 CENTURION PKWY N
JACKSONVILLE FL
32256-0532
US

V. Phone/Fax

Practice location:
  • Phone: 407-303-2528
  • Fax: 407-303-2760
Mailing address:
  • Phone: 904-697-4100
  • Fax: 904-697-5102

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAPRN11000871
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code363LN0000X
TaxonomyNeonatal Nurse Practitioner
License NumberAPRN-1263
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: