Healthcare Provider Details

I. General information

NPI: 1356782445
Provider Name (Legal Business Name): MIREI MALAVE NP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/17/2013
Last Update Date: 02/18/2025
Certification Date: 02/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1365 CLIFTON RD NE BUILDING B -SUITE 1200
ATLANTA GA
30322-1013
US

IV. Provider business mailing address

420 SE 8TH ST
OCALA FL
34471-3760
US

V. Phone/Fax

Practice location:
  • Phone: 404-778-3184
  • Fax: 706-238-8011
Mailing address:
  • Phone: 352-304-6480
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberAPRN11014767
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: