MEDICARE: JACQUELYN NICOLE MOLINA

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	103K00000X	Behavior Analyst	1-19-34454	FL
2	103K00000X	Behavior Analyst		FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1376888933
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JACQUELYN NICOLE MOLINA

Provider Business Mailing Address
First Line	:	10300 SW 72ND ST STE 114
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33173-3038
Country	:	US
Telephone Number	:	305-508-5580
Fax Number	:

Provider Business Practice Location Address
First Line	:	2520 CORAL WAY
Second Line	:	SUITE 2-19
City	:	MIAMI
State	:	FL
Zip	:	33145-3438
Country	:	US
Telephone Number	:	855-832-6727
Fax Number	:	772-675-9100

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

Provider Enumeration Date	:	12/06/2012
Last Update Date	:	02/11/2026

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