Provider Demographics
NPI:1124536438
Name:MALIK, STEPHANIE HIRES (FNP-C)
Entity type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:HIRES
Last Name:MALIK
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8676 CANYON CREEK TRL
Mailing Address - Street 2:
Mailing Address - City:PARRISH
Mailing Address - State:FL
Mailing Address - Zip Code:34219-1367
Mailing Address - Country:US
Mailing Address - Phone:610-304-3169
Mailing Address - Fax:
Practice Address - Street 1:230 HARBOR VILLAGE LN
Practice Address - Street 2:
Practice Address - City:APOLLO BEACH
Practice Address - State:FL
Practice Address - Zip Code:33572-3424
Practice Address - Country:US
Practice Address - Phone:813-645-2003
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-01-21
Last Update Date:2025-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP018398363LF0000X
FLAPRN11030403363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily