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General NPI Number Information
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NPI Number | 1619531951
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Entity Type | Individual
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Provider Name | MOLLIE MARIE WILT PA
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Gender | Female
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Dates
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Enumeration Date | 04/23/2019
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Last Update Date | 04/23/2024
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Provider Practice Location Address
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Address Line | 2910 SE 3RD CT STE A
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City | OCALA
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State | FL
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Zip | 34471-0484
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Country | US
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Telephone | 352-732-0339
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Fax | 352-732-3715
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Provider Business Mailing Address
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Address Line | 900 VILLAGE SQUARE XING STE 290
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City | PALM BEACH GARDENS
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State | FL
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Zip | 33410-4552
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Country | US
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Telephone | 239-360-3792
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Fax | 239-666-9211
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | PA9112258
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License Number State | FL
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