Healthcare Provider Details

I. General information

NPI: 1669355384
Provider Name (Legal Business Name): JENNIFER ELIZABETH MOLES NP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/29/2025
Last Update Date: 06/04/2026
Certification Date: 06/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

514 W NOBLE AVE
WILLISTON FL
32696-2036
US

IV. Provider business mailing address

6551 NE 120TH TER
WILLISTON FL
32696-4708
US

V. Phone/Fax

Practice location:
  • Phone: 574-596-8267
  • Fax: 574-596-8267
Mailing address:
  • Phone: 574-596-8267
  • Fax: 574-596-8267

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number11045956
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: