Healthcare Provider Details

I. General information

NPI: 1841136405
Provider Name (Legal Business Name): MALAK HAIFA PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/27/2026
Last Update Date: 05/21/2026
Certification Date: 05/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

326 S 6TH AVE
WAUCHULA FL
33873-3207
US

IV. Provider business mailing address

326 S 6TH AVE
WAUCHULA FL
33873-3207
US

V. Phone/Fax

Practice location:
  • Phone: 813-701-5804
  • Fax:
Mailing address:
  • Phone: 813-701-5804
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: