Healthcare Provider Details

I. General information

NPI: 1699302034
Provider Name (Legal Business Name): JESSICA LYNN MOLOKIE MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/25/2020
Last Update Date: 01/08/2024
Certification Date: 01/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1005 JOE DIMAGGIO DR
HOLLYWOOD FL
33021-5402
US

IV. Provider business mailing address

1117 E HALLANDALE BEACH BLVD
HALLANDALE BEACH FL
33009-4488
US

V. Phone/Fax

Practice location:
  • Phone: 732-299-1838
  • Fax:
Mailing address:
  • Phone: 954-454-5131
  • Fax: 954-241-6908

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberME162955
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: