Provider Demographics
NPI:1174062962
Name:MALEJKO, GINA-MARIE NOLAN (ARNP)
Entity type:Individual
Prefix:
First Name:GINA-MARIE
Middle Name:NOLAN
Last Name:MALEJKO
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:PO BOX 748519
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30374-8519
Mailing Address - Country:US
Mailing Address - Phone:904-376-3800
Mailing Address - Fax:904-396-8971
Practice Address - Street 1:302 3RD ST STE 3
Practice Address - Street 2:
Practice Address - City:NEPTUNE BEACH
Practice Address - State:FL
Practice Address - Zip Code:32266-5139
Practice Address - Country:US
Practice Address - Phone:904-376-3800
Practice Address - Fax:904-390-7427
Is Sole Proprietor?:No
Enumeration Date:2017-02-14
Last Update Date:2024-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9364192363L00000X
FLAPRN9364192363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL020388500Medicaid