Provider Demographics
NPI:1689683047
Name:MALLARI, ERIN E (PA-C)
Entity type:Individual
Prefix:
First Name:ERIN
Middle Name:E
Last Name:MALLARI
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:ERIN
Other - Middle Name:E
Other - Last Name:ROSS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:8791 CONFERENCE DR STE 100
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33919-5822
Mailing Address - Country:US
Mailing Address - Phone:239-331-5566
Mailing Address - Fax:239-437-7499
Practice Address - Street 1:8791 CONFERENCE DR STE 100
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33919-5822
Practice Address - Country:US
Practice Address - Phone:239-331-5566
Practice Address - Fax:239-437-7499
Is Sole Proprietor?:No
Enumeration Date:2006-08-05
Last Update Date:2024-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9103462363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL292574500Medicaid
FLLG171OtherMEDICARE
FLY01T5OtherBLUE CROSS BLUE SHIELD