Provider Demographics
NPI:1083213102
Name:MALICK, PAIGE (PA-C)
Entity type:Individual
Prefix:
First Name:PAIGE
Middle Name:
Last Name:MALICK
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5979 VINELAND RD STE 310
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32819-7856
Mailing Address - Country:US
Mailing Address - Phone:407-345-0005
Mailing Address - Fax:407-352-8585
Practice Address - Street 1:5979 VINELAND RD STE 310
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32819-7856
Practice Address - Country:US
Practice Address - Phone:407-345-0005
Practice Address - Fax:407-352-8585
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-20
Last Update Date:2024-09-25
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLPA911926363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant