Provider Demographics
NPI:1114160900
Name:MALIS, KAREN KATHLEEN (ARNP)
Entity Type:Individual
Prefix:MISS
First Name:KAREN
Middle Name:KATHLEEN
Last Name:MALIS
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 1:3042 PERSIMMON CIR W
Mailing Address - Street 2:
Mailing Address - City:FERNANDINA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32034-5284
Mailing Address - Country:US
Mailing Address - Phone:904-608-2098
Mailing Address - Fax:
Practice Address - Street 1:3042 PERSIMMON CIR W
Practice Address - Street 2:
Practice Address - City:FERNANDINA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32034-5284
Practice Address - Country:US
Practice Address - Phone:904-608-2098
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-09
Last Update Date:2009-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9235083363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health