Provider Demographics
NPI:1922463413
Name:ALVES, MALLORY (NP)
Entity Type:Individual
Prefix:MRS
First Name:MALLORY
Middle Name:
Last Name:ALVES
Suffix:
Gender:F
Credentials:NP
Other - Prefix:MISS
Other - First Name:MALLORY
Other - Middle Name:
Other - Last Name:KINCAID
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:2950 SW 3RD AVE APT 8D
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33129-2763
Mailing Address - Country:US
Mailing Address - Phone:407-337-3007
Mailing Address - Fax:240-666-8620
Practice Address - Street 1:2950 SW 3RD AVE APT 8D
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33129-2763
Practice Address - Country:US
Practice Address - Phone:407-337-3007
Practice Address - Fax:240-666-8620
Is Sole Proprietor?:Yes
Enumeration Date:2015-12-28
Last Update Date:2021-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11002249363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health