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General NPI Number Information
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NPI Number | 1275913907
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Entity Type | Individual
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Provider Name | ANNA E MALINE PA-C
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Gender | Female
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Dates
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Enumeration Date | 06/08/2015
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Last Update Date | 01/29/2025
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Provider Practice Location Address
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Address Line | 1034 SE PROCTOR LN
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City | PORT ST LUCIE
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State | FL
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Zip | 34983-2616
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Country | US
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Telephone | 772-595-5150
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Fax |
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Provider Business Mailing Address
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Address Line | 1034 SE PROCTOR LN
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City | PORT ST LUCIE
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State | FL
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Zip | 34983-2616
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Country | US
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Telephone | 724-991-2111
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | OA003849
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License Number State | PA
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Taxonomy #2
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | PA9115737
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License Number State | FL
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Taxonomy #3
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | MA057603
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License Number State | PA
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