Healthcare Provider Details

I. General information

NPI: 1740029263
Provider Name (Legal Business Name): MALINET GARCIA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/23/2024
Last Update Date: 05/23/2024
Certification Date: 05/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2685 SW FAIR ISLE RD
PORT ST LUCIE FL
34987-2093
US

IV. Provider business mailing address

2685 SW FAIR ISLE RD
PORT ST LUCIE FL
34987-2093
US

V. Phone/Fax

Practice location:
  • Phone: 772-626-6010
  • Fax:
Mailing address:
  • Phone: 772-626-6010
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number11032935
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: