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General NPI Number Information
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NPI Number | 1336483015
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Entity Type | Individual
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Provider Name | MOLLY M MULLANEY PA-C
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Gender | Female
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Dates
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Enumeration Date | 11/19/2012
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Last Update Date | 10/07/2025
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Provider Practice Location Address
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Address Line | 6555 CHESTER AVE STE 1
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City | JACKSONVILLE
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State | FL
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Zip | 32217-2279
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Country | US
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Telephone | 904-265-8209
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Fax | 904-503-3577
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Provider Business Mailing Address
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Address Line | 2316 INDIAN SPRINGS DR
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City | JACKSONVILLE
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State | FL
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Zip | 32246-4184
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Country | US
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Telephone | 919-302-9524
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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 | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | PA9106964
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License Number State | FL
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