Healthcare Provider Details

I. General information

NPI: 1639977069
Provider Name (Legal Business Name): MOLLY ROY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MOLLY GRACE ROY

II. Dates (important events)

Enumeration Date: 03/03/2025
Last Update Date: 06/03/2026
Certification Date: 06/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12907 PANAMA CITY BEACH PKWY
PANAMA CITY BEACH FL
32407-2717
US

IV. Provider business mailing address

2505 HARRISON AVE
PANAMA CITY FL
32405-4423
US

V. Phone/Fax

Practice location:
  • Phone: 850-233-3376
  • Fax: 850-522-8354
Mailing address:
  • Phone: 850-233-3376
  • Fax: 850-522-8354

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN324277
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN11045012
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: