Provider Demographics
NPI:1336674043
Name:MALPEDO, RITA M (ARNP)
Entity Type:Individual
Prefix:
First Name:RITA
Middle Name:M
Last Name:MALPEDO
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 1:600 NOKOMIS AVE S STE 102&203
Mailing Address - Street 2:
Mailing Address - City:VENICE
Mailing Address - State:FL
Mailing Address - Zip Code:34285-3209
Mailing Address - Country:US
Mailing Address - Phone:941-486-6979
Mailing Address - Fax:941-486-6964
Practice Address - Street 1:600 NOKOMIS AVE S STE 102&203
Practice Address - Street 2:
Practice Address - City:VENICE
Practice Address - State:FL
Practice Address - Zip Code:34285
Practice Address - Country:US
Practice Address - Phone:941-486-6979
Practice Address - Fax:941-486-6964
Is Sole Proprietor?:Yes
Enumeration Date:2017-05-01
Last Update Date:2020-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9302726363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner