Provider Demographics
NPI:1558089607
Name:MALCOLM, VIVARIAN NICOLE (FNP-C)
Entity type:Individual
Prefix:MRS
First Name:VIVARIAN
Middle Name:NICOLE
Last Name:MALCOLM
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7229 US HIGHWAY 301 S
Mailing Address - Street 2:
Mailing Address - City:RIVERVIEW
Mailing Address - State:FL
Mailing Address - Zip Code:33578-4346
Mailing Address - Country:US
Mailing Address - Phone:813-677-8418
Mailing Address - Fax:813-355-5906
Practice Address - Street 1:7229 US HIGHWAY 301 S
Practice Address - Street 2:
Practice Address - City:RIVERVIEW
Practice Address - State:FL
Practice Address - Zip Code:33578-4346
Practice Address - Country:US
Practice Address - Phone:813-677-8418
Practice Address - Fax:813-355-5906
Is Sole Proprietor?:No
Enumeration Date:2022-08-16
Last Update Date:2024-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN11021420363L00000X, 363LF0000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner