Healthcare Provider Details

I. General information

NPI: 1003730276
Provider Name (Legal Business Name): MARYNITH JAVELOSA DE LAS ALAS APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

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

III. Provider practice location address

4601 HEAVENS WAY
NEW PORT RICHEY FL
34652-1521
US

IV. Provider business mailing address

4601 HEAVENS WAY
NEW PORT RICHEY FL
34652-1521
US

V. Phone/Fax

Practice location:
  • Phone: 407-552-9942
  • Fax:
Mailing address:
  • Phone: 407-552-9942
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberAPRN11049805
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License NumberAPRN11049805
License Number StateFL
# 3
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAPRN11049805
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: