Healthcare Provider Details

I. General information

NPI: 1609703677
Provider Name (Legal Business Name): ERIC MALZ APN
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/05/2026
Last Update Date: 05/05/2026
Certification Date: 05/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2683 IRMA LAKE DR
WEST PALM BEACH FL
33411-5735
US

IV. Provider business mailing address

2683 IRMA LAKE DR WEST PALM BEACH
WEST PALM BEACH FL
33411-5735
US

V. Phone/Fax

Practice location:
  • Phone: 561-289-7816
  • Fax: 551-804-1618
Mailing address:
  • Phone: 561-289-7816
  • Fax: 551-804-1618

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: MR. ERIC MALZ
Title or Position: PSYCHIATRIC NURSE PRACTITIONER
Credential: PMHNP-BC
Phone: 551-804-1618