MEDICARE: MS. MOLLY ANNE NICHOLAS ARNP

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	363L00000X	Nurse Practitioner	ARNP3048822	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	11711668	OTHER		CAQH
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1629097555
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. MOLLY ANNE NICHOLAS ARNP

Provider Business Mailing Address
First Line	:	8117 SW 12TH PL
Second Line	:
City	:	GAINESVILLE
State	:	FL
Zip	:	32607-3329
Country	:	US
Telephone Number	:	352-317-6361
Fax Number	:

Provider Business Practice Location Address
First Line	:	5818 CENTRE ST
Second Line	:
City	:	MELROSE
State	:	FL
Zip	:	32666-6207
Country	:	US
Telephone Number	:	352-475-3792
Fax Number	:	352-475-3794

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

Provider Enumeration Date	:	07/19/2006
Last Update Date	:	10/30/2018

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