Provider Demographics
NPI:1609408160
Name:HERNANDEZ, MOLLY JOAN (FNP)
Entity Type:Individual
Prefix:
First Name:MOLLY
Middle Name:JOAN
Last Name:HERNANDEZ
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:899 N SUMMIT ST
Mailing Address - Street 2:
Mailing Address - City:CRESCENT CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32112-2109
Mailing Address - Country:US
Mailing Address - Phone:386-698-1088
Mailing Address - Fax:386-698-1099
Practice Address - Street 1:899 N SUMMIT ST
Practice Address - Street 2:
Practice Address - City:CRESCENT CITY
Practice Address - State:FL
Practice Address - Zip Code:32112-2109
Practice Address - Country:US
Practice Address - Phone:386-698-1088
Practice Address - Fax:386-698-1099
Is Sole Proprietor?:No
Enumeration Date:2020-02-12
Last Update Date:2021-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11006138363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily