Provider Demographics
NPI:1093378622
Name:PAEZ, MAYLIN (ARNP)
Entity Type:Individual
Prefix:
First Name:MAYLIN
Middle Name:
Last Name:PAEZ
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3977 POMODORO CIR APT 201
Mailing Address - Street 2:
Mailing Address - City:CAPE CORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33909-5467
Mailing Address - Country:US
Mailing Address - Phone:561-222-6347
Mailing Address - Fax:
Practice Address - Street 1:12247 BRISBANE LN
Practice Address - Street 2:
Practice Address - City:WELLINGTON
Practice Address - State:FL
Practice Address - Zip Code:33414-5533
Practice Address - Country:US
Practice Address - Phone:561-222-6347
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-04-18
Last Update Date:2021-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11011530363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner