NPI Code Detail JSON Logo

1619531951 NPI number — MOLLIE MARIE WILT PA

NPI Number: 1619531951
Health Care Provider/Practitioner: MOLLIE MARIE WILT PA

Information about “1619531951” NPI (MOLLIE MARIE WILT PA) exists in 1619531951 in HTML format HTML  |  1619531951 in plain Text format TXT  |  1619531951 in PDF (Portable Document Format) PDF  |  1619531951 in an XML format XML  formats.

NPI Number : 1619531951 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1619531951",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "WILT",
    "FirstName": "MOLLIE",
    "MiddleName": "MARIE",
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": "PA",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": "PLEASANTON",
    "OtherFirstName": "MOLLIE",
    "OtherMiddleName": "MARIE",
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": "PA-C",
    "OtherLastNameTypeCode": "1",
    "FirstLineMailingAddress": "900 VILLAGE SQUARE XING STE 290",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "PALM BEACH GARDENS",
    "MailingAddressStateName": "FL",
    "MailingAddressPostalCode": "33410-4552",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "239-360-3792",
    "MailingAddressFaxNumber": "239-666-9211",
    "FirstLinePracticeLocationAddress": "2910 SE 3RD CT STE A",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "OCALA",
    "PracticeLocationAddressStateName": "FL",
    "PracticeLocationAddressPostalCode": "34471-0484",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "352-732-0339",
    "PracticeLocationAddressFaxNumber": "352-732-3715",
    "EnumerationDate": "04/23/2019",
    "LastUpdateDate": "04/23/2024",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": "F",
    "Gender": "Female",
    "AuthorizedOfficialLastName": null,
    "AuthorizedOfficialFirstName": null,
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": null,
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": null,
    "Taxonomies": {
      "Taxonomy": {
        "TaxonomyCode": "363A00000X",
        "TaxonomyName": "Physician Assistant",
        "LicenseNumber": "PA9112258",
        "LicenseNumberStateCode": "FL",
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

Copyright © 2007-2026 Data Labs Health. All rights reserved.