Healthcare Provider Details

I. General information

NPI: 1114830684
Provider Name (Legal Business Name): BRITTANY MOLINA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/25/2026
Last Update Date: 09/25/2026
Certification Date: 09/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1628 SAN MARCO BLVD STE 1A
JACKSONVILLE FL
32207-3066
US

IV. Provider business mailing address

1628 SAN MARCO BLVD STE 1A
JACKSONVILLE FL
32207-3066
US

V. Phone/Fax

Practice location:
  • Phone: 904-894-5688
  • Fax:
Mailing address:
  • Phone: 904-894-5688
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberCL0185480
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: