Healthcare Provider Details

I. General information

NPI: 1235057597
Provider Name (Legal Business Name): NINA MAILLIARD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/06/2026
Last Update Date: 07/06/2026
Certification Date: 07/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10743 NARCOOSSEE RD STE A12
ORLANDO FL
32832-6946
US

IV. Provider business mailing address

1010 UMBRIA LN
SAINT CLOUD FL
34771-7960
US

V. Phone/Fax

Practice location:
  • Phone: 407-501-8488
  • Fax:
Mailing address:
  • Phone: 407-501-8488
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberAP4707
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: