Provider Demographics
NPI:1235585803
Name:MALQUIST, MICHELLE
Entity Type:Individual
Prefix:MRS
First Name:MICHELLE
Middle Name:
Last Name:MALQUIST
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7575 DR PHILLIPS BLVD
Mailing Address - Street 2:#155
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32819-7216
Mailing Address - Country:US
Mailing Address - Phone:407-574-8383
Mailing Address - Fax:
Practice Address - Street 1:7575 DR PHILLIPS BLVD
Practice Address - Street 2:#155
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32819-7216
Practice Address - Country:US
Practice Address - Phone:407-574-8383
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-05-12
Last Update Date:2016-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL48-44-1429053246ZA2600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZA2600XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherArt, Medical