MEDICARE: MALON DEVINE CRNA, ARNP

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
1	367500000X	Certified Registered Nurse Anesthetist	ARNP9188141	FL
2	363LF0000X	Family Nurse Practitioner	ARNP9188141	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	ARNP9188141	OTHER	FL	REGISTERED NURSE PRACTION

General Provider Information

NPI Number	:	1578599676
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MALON DEVINE CRNA, ARNP

Provider Business Mailing Address
First Line	:	335 E LINTON BLVD STE 2236
Second Line	:
City	:	DELRAY BEACH
State	:	FL
Zip	:	33483-5023
Country	:	US
Telephone Number	:	561-613-7359
Fax Number	:	561-613-7359

Provider Business Practice Location Address
First Line	:	335 E LINTON BLVD STE 2236
Second Line	:
City	:	DELRAY BEACH
State	:	FL
Zip	:	33483-5023
Country	:	US
Telephone Number	:	561-613-7359
Fax Number	:	561-613-7359

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/23/2006
Last Update Date	:	08/02/2016

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