AUTUM MARIE MALLICK (NPI# 1578108627) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1578108627 |
| Entity Type | Individual |
| Full Name | AUTUM MARIE MALLICK |
| Practice Address |
7165 Tee Don Ct Holt FL 32564-8925 |
| Practice Telephone | 8503139846 |
| Mailing Telephone | 8503139846 |
| Enumeration Date | 2019-11-13 |
| Last Update Date | 2019-11-14 |
| Gender Code | F |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 372500000X | Chore Provider | Nursing Service Related Providers | ||
| Y | 3747A0650X |
Technician Specialization: Attendant Care Provider |
Nursing Service Related Providers |
| Street Address |
7165 TEE DON CT |
| City | HOLT |
| State | FL |
| Zip Code | 32564-8925 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1770606550 | Michelle Moody | Social Worker | 12364 Environment Center Rd, Holt, FL 32564 | 2007-04-09 |
| 1568678514 | Santa Rosa Youth Academy | Substance Abuse Rehabilitation Facility | 12364 Environmental Center Rd, Holt, FL 32564-9126 | 2007-05-15 |
| 1053937250 | Victoria Rawlins | Physician Assistant | 5127 Griffith Mill Rd, Holt, FL 32564-9317 | 2020-06-23 |
| 1588901433 | Terry Ladon Gordon | Pharmacist | 498 Yellow River Ln, Holt, FL 32564-9570 | 2013-01-12 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1518567890 | Mcap Holt Opco LLC | Assisted Living Facility | 4300 Keller Rd, Holt, MI 48842-1268 | 2020-10-27 |
| 1629682679 | Madison Rose Mcwethy | Specialist/Technologist | 2646 Fontaine Trl, Holt, MI 48842-9722 | 2020-09-06 |
| 1184238966 | Med Clubs | Family Medicine | 2575 Hummingbird Dr, Holt, MI 48842-9430 | 2020-08-31 |
| 1053937250 | Victoria Rawlins | Physician Assistant | 5127 Griffith Mill Rd, Holt, FL 32564-9317 | 2020-06-23 |
| 1255954939 | Jon Freburg | Counselor | 3941 Marimba Rd, Holt, MI 48842-8786 | 2020-05-28 |
| 1992324438 | Betty Anne Bogart | Technician | 19108 Old Bb, Holt, MO 64048-8751 | 2020-04-14 |
| 1730708538 | Dylan Voris | Psychologist | 4523 E Willoughby Rd., Holt, MI 48842 | 2020-04-11 |
| 1790311868 | James Robert Owens | Counselor | 4100 Pheasant Run, Holt, MI 48842-8772 | 2020-03-20 |
| 1700444114 | Christina H Nguyen | Dentist | 4488 Holt Rd, Holt, MI 48842-1673 | 2019-05-31 |
| 1538626221 | Crossroads Orthotics & Consultation, Inc. | Prosthetic/Orthotic Supplier | 4025 Holt Rd Ste 110, Holt, MI 48842-6019 | 2019-02-28 |
| Find all providers in HOLT | ||||
| Taxonomy Code | 3747A0650X |
| Grouping | Nursing Service Related Providers |
| Classification | Technician |
| Specialization | Attendant Care Provider |
| An individual who provides hands-on care, of both a supportive and health related nature, specific to the needs of a medically stable, physically handicapped individual. Supportive services are those that substitute for the absence, loss, diminution, or impairment of a physical or cognitive function. This service may include skilled or nursing care to the extent permitted by state law. |
| Notes: [7/1/2003: new] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1992324438 | Betty Anne Bogart | Technician | 19108 Old Bb, Holt, MO 64048-8751 | 2020-04-14 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1699388801 | Tara Danielle Burgett | Technician | 6437 Maddox Rd, Milton, FL 32570-6327 | 2020-08-26 |
| 1932711678 | Julie Jayne Christofferson | Technician | 4009 Deerwood Cir, Pace, FL 32571-1108 | 2020-08-22 |
| 1386252062 | Rosa M Stephens | Technician | 6002 Vel St, Wimauma, FL 33598-3021 | 2020-07-17 |
| 1487279121 | Michelle Hill | Technician | 75 N Gulf Ave, Crystal River, FL 34429-7611 | 2020-06-09 |
| 1487278628 | Marcia Marie Long | Technician | 454 Georgetown Shortcut Rd, Crescent City, FL 32112-4504 | 2020-06-03 |
| 1740802289 | Anna Marie Cruttenden | Technician | 4336 Sablan Ln, Milton, FL 32583-2470 | 2020-05-06 |
| 1619597507 | Lula Curry | Technician | 106 W Jersey Ave, Brandon, FL 33510-3130 | 2020-04-21 |
| 1447879721 | Bretton Hill | Technician | 1227 Rolling Stone Run, Odessa, FL 33556-6040 | 2020-04-16 |
| 1770119653 | Stephanie J Crenshaw | Technician | 2154 Waseca Ln, Leesburg, FL 34748-3059 | 2020-03-23 |
| 1770118259 | Tatiyana Anisimova | Technician | 2605 Casa Dr, New Port Richey, FL 34655-2235 | 2020-03-05 |
| Find all providers with the same taxonomy | ||||
Please comment or provide details below to improve the information on AUTUM MARIE MALLICK.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.