Provider Demographics
NPI:1275913907
Name:MALINE, ANNA E (PA-C)
Entity type:Individual
Prefix:
First Name:ANNA
Middle Name:E
Last Name:MALINE
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 1:1034 SE PROCTOR LN
Mailing Address - Street 2:
Mailing Address - City:PORT ST LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34983-2616
Mailing Address - Country:US
Mailing Address - Phone:724-991-2111
Mailing Address - Fax:
Practice Address - Street 1:1034 SE PROCTOR LN
Practice Address - Street 2:
Practice Address - City:PORT ST LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34983-2616
Practice Address - Country:US
Practice Address - Phone:772-595-5150
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-06-08
Last Update Date:2025-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOA003849363A00000X
FLPA9115737363A00000X
PAMA057603363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant