Healthcare Provider Details

I. General information

NPI: 1275354433
Provider Name (Legal Business Name): MOLLY DRACH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/21/2024
Last Update Date: 01/28/2025
Certification Date: 01/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13685 DOCTORS WAY STE 100
FORT MYERS FL
33912-4337
US

IV. Provider business mailing address

PO BOX 2147
FORT MYERS FL
33902-2147
US

V. Phone/Fax

Practice location:
  • Phone: 239-343-1612
  • Fax: 239-343-4229
Mailing address:
  • Phone: 239-343-1612
  • Fax: 239-343-4229

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number9119375
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: