Provider Demographics
NPI:1275798274
Name:MOLINARES, JENNIFER VICTORIA
Entity Type:Individual
Prefix:MISS
First Name:JENNIFER
Middle Name:VICTORIA
Last Name:MOLINARES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4706 SOAPSTONE DR
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33615-4928
Mailing Address - Country:US
Mailing Address - Phone:813-352-8501
Mailing Address - Fax:
Practice Address - Street 1:4706 SOAPSTONE DR
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33615-4928
Practice Address - Country:US
Practice Address - Phone:786-564-8671
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-19
Last Update Date:2015-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA42181225700000X
FLAP3489171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
No171100000XOther Service ProvidersAcupuncturist