Provider Demographics
NPI:1598454712
Name:WOLFE, MOLLIE (PA-C)
Entity Type:Individual
Prefix:
First Name:MOLLIE
Middle Name:
Last Name:WOLFE
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4758 CUMBERLAND STATION CT
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32257-5111
Mailing Address - Country:US
Mailing Address - Phone:912-614-6465
Mailing Address - Fax:904-329-2303
Practice Address - Street 1:8823 SAN JOSE BLVD
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32217-4287
Practice Address - Country:US
Practice Address - Phone:904-404-7044
Practice Address - Fax:904-329-2303
Is Sole Proprietor?:No
Enumeration Date:2023-05-03
Last Update Date:2023-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9117374363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant