Healthcare Provider Details

I. General information

NPI: 1255126876
Provider Name (Legal Business Name): SUSAN MOLINA RN BSN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/14/2025
Last Update Date: 04/14/2025
Certification Date: 04/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4101 COLLEGE ST STE 1
JACKSONVILLE FL
32205-5318
US

IV. Provider business mailing address

11229 BELMONT OAKS DR
JACKSONVILLE FL
32220-3700
US

V. Phone/Fax

Practice location:
  • Phone: 904-387-0370
  • Fax: 904-387-0156
Mailing address:
  • Phone: 440-570-5438
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN368333
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number9323314
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: