Healthcare Provider Details

I. General information

NPI: 1609156561
Provider Name (Legal Business Name): DONNA D MALONE DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/24/2011
Last Update Date: 11/18/2025
Certification Date: 11/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1806 SHORT BRANCH DR STE 101
TRINITY FL
34655-4426
US

IV. Provider business mailing address

1806 SHORT BRANCH DR STE 101
TRINITY FL
34655-4426
US

V. Phone/Fax

Practice location:
  • Phone: 727-372-0873
  • Fax: 888-402-1685
Mailing address:
  • Phone: 904-338-5442
  • Fax: 888-402-1685

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberOS12292
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: