Healthcare Provider Details

I. General information

NPI: 1457993586
Provider Name (Legal Business Name): KALI GARCIA MALPICA ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/10/2019
Last Update Date: 10/23/2024
Certification Date: 10/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1853 SE PORT ST LUCIE BLVD
PORT SAINT LUCIE FL
34952-5530
US

IV. Provider business mailing address

1853 SE PORT ST LUCIE BLVD
PORT SAINT LUCIE FL
34952-5530
US

V. Phone/Fax

Practice location:
  • Phone: 772-237-5244
  • Fax: 772-905-8047
Mailing address:
  • Phone: 772-237-5244
  • Fax: 772-905-8047

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN11003836
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: