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NPI Code Detail

MEDICARE: MR. DENIS MICHAEL MALCOLM N.P.

MEDICARE: MR. DENIS MICHAEL MALCOLM N.P.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363LF0000XFamily Nurse Practitioner681173TX
2363LF0000XFamily Nurse PractitionerARNP9321278FL

General Provider Information

NPI Number : 1154316073
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. DENIS MICHAEL MALCOLM N.P.
Provider Business Mailing Address
First Line : 1495 N HARBOR CITY BLVD STE E
Second Line :
City : MELBOURNE
State : FL
Zip : 32935-6572
Country : US
Telephone Number : 321-253-0846
Fax Number :
Provider Business Practice Location Address
First Line : 1495 N HARBOR CITY BLVD STE E
Second Line :
City : MELBOURNE
State : FL
Zip : 32935-6572
Country : US
Telephone Number : 321-253-0846
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/16/2005
Last Update Date : 06/13/2012

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