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General NPI Number Information
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NPI Number | 1275211856
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Entity Type | Individual
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Provider Name | MOLLY MICHELLE WHITE APRN, FNP-C
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Gender | Female
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Dates
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Enumeration Date | 07/05/2023
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Last Update Date | 07/05/2023
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Provider Practice Location Address
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Address Line | 12620 BEACH BLVD STE 6
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City | JACKSONVILLE
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State | FL
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Zip | 32246-7130
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Country | US
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Telephone | 904-635-0777
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Fax | 904-545-3483
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Provider Business Mailing Address
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Address Line | 4001 SIOUX CIR
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City | SAINT JOHNS
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State | FL
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Zip | 32259-2147
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Country | US
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Telephone | 904-885-4953
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 11027293
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License Number State | FL
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