Provider Demographics
NPI:1407074099
Name:MOLINA, JOSE ENRIQUE SR (PA)
Entity Type:Individual
Prefix:DR
First Name:JOSE
Middle Name:ENRIQUE
Last Name:MOLINA
Suffix:SR
Gender:M
Credentials:PA
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Mailing Address - Street 1:601 S HARBOUR ISLAND BLVD STE 200
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33602-5925
Mailing Address - Country:US
Mailing Address - Phone:727-322-3439
Mailing Address - Fax:
Practice Address - Street 1:3100 17TH ST STE B
Practice Address - Street 2:
Practice Address - City:SAINT CLOUD
Practice Address - State:FL
Practice Address - Zip Code:34769-6021
Practice Address - Country:US
Practice Address - Phone:407-908-7310
Practice Address - Fax:844-388-6186
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-22
Last Update Date:2023-02-03
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
FLPA9100698363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant