Provider Demographics
NPI:1972051241
Name:MALAFRONTE, CLARISSA GABRIEL (APRN)
Entity Type:Individual
Prefix:
First Name:CLARISSA
Middle Name:GABRIEL
Last Name:MALAFRONTE
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:CLARISSA
Other - Middle Name:
Other - Last Name:GABRIEL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APRN
Mailing Address - Street 1:4919 MEMORIAL HWY STE 150
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33634-7516
Mailing Address - Country:US
Mailing Address - Phone:813-333-1512
Mailing Address - Fax:813-333-1561
Practice Address - Street 1:3622 MADACA LN
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33618-2057
Practice Address - Country:US
Practice Address - Phone:813-513-3643
Practice Address - Fax:813-605-5465
Is Sole Proprietor?:No
Enumeration Date:2016-09-15
Last Update Date:2023-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN9316294363L00000X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLBP2XDOtherBLUE CROSS AND BLUE SHIELD #