Provider Demographics
NPI:1366709859
Name:MALKIN, INNA (CRNA)
Entity type:Individual
Prefix:
First Name:INNA
Middle Name:
Last Name:MALKIN
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:INNA
Other - Middle Name:
Other - Last Name:KHARAST
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:956 TILLERY WAY
Mailing Address - Street 2:NONE
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32828-9150
Mailing Address - Country:US
Mailing Address - Phone:407-432-0290
Mailing Address - Fax:
Practice Address - Street 1:7111 FAIRWAY DR
Practice Address - Street 2:
Practice Address - City:PALM BEACH GARDENS
Practice Address - State:FL
Practice Address - Zip Code:33418-4204
Practice Address - Country:US
Practice Address - Phone:561-799-3552
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-04-20
Last Update Date:2012-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9249802367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered