Healthcare Provider Details

I. General information

NPI: 1407074099
Provider Name (Legal Business Name): JOSE ENRIQUE MOLINA SR. P.A.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/22/2007
Last Update Date: 02/03/2023
Certification Date: 02/03/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3100 17TH ST STE B
SAINT CLOUD FL
34769-6021
US

IV. Provider business mailing address

601 S HARBOUR ISLAND BLVD STE 200
TAMPA FL
33602-5925
US

V. Phone/Fax

Practice location:
  • Phone: 407-908-7310
  • Fax: 844-388-6186
Mailing address:
  • Phone: 727-322-3439
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA9100698
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: