Provider Demographics
NPI:1093366486
Name:MOLINA-MADRID, MELISSA (PA)
Entity Type:Individual
Prefix:MRS
First Name:MELISSA
Middle Name:
Last Name:MOLINA-MADRID
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11001 W COLONIAL DR STE 120
Mailing Address - Street 2:
Mailing Address - City:OCOEE
Mailing Address - State:FL
Mailing Address - Zip Code:34761-2937
Mailing Address - Country:US
Mailing Address - Phone:321-221-7730
Mailing Address - Fax:
Practice Address - Street 1:11001 W COLONIAL DR STE 120
Practice Address - Street 2:
Practice Address - City:OCOEE
Practice Address - State:FL
Practice Address - Zip Code:34761-2937
Practice Address - Country:US
Practice Address - Phone:321-221-7730
Practice Address - Fax:321-221-7731
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-26
Last Update Date:2022-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9112588363A00000X, 363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant