Provider Demographics
NPI:1013570779
Name:MOLINA ZAMORA, MARLO JAVIER (CRNA)
Entity Type:Individual
Prefix:
First Name:MARLO
Middle Name:JAVIER
Last Name:MOLINA ZAMORA
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1701 N LOIS AVE APT UNIT224
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33607-2352
Mailing Address - Country:US
Mailing Address - Phone:956-254-6710
Mailing Address - Fax:
Practice Address - Street 1:1701 N LOIS AVE APT UNIT224
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33607-2352
Practice Address - Country:US
Practice Address - Phone:956-254-6710
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-18
Last Update Date:2019-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN11001411367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified RegisteredGroup - Single Specialty