MEDICARE: MOLLY LENAHAN P.A.-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363A00000X	Physician Assistant	PA 1862	FL

General Provider Information

NPI Number	:	1902876253
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MOLLY LENAHAN P.A.-C

Provider Business Mailing Address
First Line	:	1895 KINGSLEY AVE
Second Line	:	SUITE 303
City	:	ORANGE PARK
State	:	FL
Zip	:	32073-4466
Country	:	US
Telephone Number	:	904-272-6161
Fax Number	:

Provider Business Practice Location Address
First Line	:	1895 KINGSLEY AVE
Second Line	:	SUITE 303
City	:	ORANGE PARK
State	:	FL
Zip	:	32073-4466
Country	:	US
Telephone Number	:	904-272-6161
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/26/2006
Last Update Date	:	07/08/2007

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