MEDICARE: JANETHE MOLINA DE PENA APRN,FNP-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	71797	NM
2	363LF0000X	Family Nurse Practitioner	866643	NV

General Provider Information

NPI Number	:	1053136937
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JANETHE MOLINA DE PENA APRN,FNP-C

Provider Business Mailing Address
First Line	:	6101 BLUE LAGOON DR STE 200
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33126-3168
Country	:	US
Telephone Number	:	702-561-0590
Fax Number	:

Provider Business Practice Location Address
First Line	:	4469 W CHARLESTON BLVD
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89102-1605
Country	:	US
Telephone Number	:	702-637-4239
Fax Number	:	877-569-2931

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/18/2024
Last Update Date	:	10/21/2025

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