Provider Demographics
NPI:1285276964
Name:DONNA MALKOVICH APRN LLC
Entity type:Organization
Organization Name:DONNA MALKOVICH APRN LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:APRN/ OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:DONNA
Authorized Official - Middle Name:ZVEZDANA
Authorized Official - Last Name:MALKOVICH
Authorized Official - Suffix:
Authorized Official - Credentials:APRN
Authorized Official - Phone:727-688-9968
Mailing Address - Street 1:11925 MANDARIN CT
Mailing Address - Street 2:
Mailing Address - City:SEMINOLE
Mailing Address - State:FL
Mailing Address - Zip Code:33772-3435
Mailing Address - Country:US
Mailing Address - Phone:727-688-9968
Mailing Address - Fax:
Practice Address - Street 1:11125 PARK BLVD STE 118
Practice Address - Street 2:
Practice Address - City:SEMINOLE
Practice Address - State:FL
Practice Address - Zip Code:33772-4700
Practice Address - Country:US
Practice Address - Phone:727-688-9968
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DONNA MALKOVICH APRN LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-10-14
Last Update Date:2021-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty