Healthcare Provider Details

I. General information

NPI: 1760886972
Provider Name (Legal Business Name): CASEY LEE MOLUMBY ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: CASEY LEE PASS RN

II. Dates (important events)

Enumeration Date: 10/17/2014
Last Update Date: 11/25/2025
Certification Date: 11/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2080 CHILD ST BLDG 964
JACKSONVILLE FL
32214-5005
US

IV. Provider business mailing address

2080 CHILD ST BLDG 964
JACKSONVILLE FL
32214-5005
US

V. Phone/Fax

Practice location:
  • Phone: 904-546-7090
  • Fax:
Mailing address:
  • Phone: 904-546-7090
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberARNP9203695
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code363LX0106X
TaxonomyOccupational Health Nurse Practitioner
License NumberARNP9203695
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: