Provider Demographics
NPI:1235230905
Name:BLADEN, MOLLY HUMBLE (APRN)
Entity Type:Individual
Prefix:MRS
First Name:MOLLY
Middle Name:HUMBLE
Last Name:BLADEN
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:MARY
Other - Middle Name:HUMBLE
Other - Last Name:NGUYEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APRN
Mailing Address - Street 1:9570 REGENCY SQUARE BLVD
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32225
Mailing Address - Country:US
Mailing Address - Phone:904-727-9624
Mailing Address - Fax:904-720-0059
Practice Address - Street 1:9570 REGENCY SQUARE BLVD
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32225
Practice Address - Country:US
Practice Address - Phone:904-727-9624
Practice Address - Fax:904-720-0059
Is Sole Proprietor?:No
Enumeration Date:2006-09-26
Last Update Date:2018-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP 2576322363LF0000X
FLAPRN2576322363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily