Provider Demographics
NPI:1619219003
Name:MALONE, CAROL MARIE (AGNP)
Entity type:Individual
Prefix:
First Name:CAROL
Middle Name:MARIE
Last Name:MALONE
Suffix:
Gender:F
Credentials:AGNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8724 STARRY NIGHT TER
Mailing Address - Street 2:
Mailing Address - City:PARRISH
Mailing Address - State:FL
Mailing Address - Zip Code:34219-1490
Mailing Address - Country:US
Mailing Address - Phone:586-596-6284
Mailing Address - Fax:
Practice Address - Street 1:1430 S DIXIE HWY STE 304
Practice Address - Street 2:
Practice Address - City:CORAL GABLES
Practice Address - State:FL
Practice Address - Zip Code:33146-3159
Practice Address - Country:US
Practice Address - Phone:888-696-4322
Practice Address - Fax:877-409-3320
Is Sole Proprietor?:No
Enumeration Date:2013-03-23
Last Update Date:2025-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704182052363L00000X, 363LA2200X
FLAPRN11037484363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health