Provider Demographics
NPI:1326352394
Name:MALECKI, LISA P (ARNP)
Entity Type:Individual
Prefix:MRS
First Name:LISA
Middle Name:P
Last Name:MALECKI
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 25317
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33622-5317
Mailing Address - Country:US
Mailing Address - Phone:813-286-0033
Mailing Address - Fax:813-282-1806
Practice Address - Street 1:625 6TH AVE S
Practice Address - Street 2:SUITE # 350
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33701-4662
Practice Address - Country:US
Practice Address - Phone:727-456-0080
Practice Address - Fax:727-456-0089
Is Sole Proprietor?:No
Enumeration Date:2010-08-02
Last Update Date:2012-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP1851002363LX0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LX0001XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerObstetrics & Gynecology