Provider Demographics
NPI:1720557598
Name:CHRISTENSEN, MOLLY (APRN, PMHNP-BC)
Entity Type:Individual
Prefix:
First Name:MOLLY
Middle Name:
Last Name:CHRISTENSEN
Suffix:
Gender:F
Credentials:APRN, PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1495 S VOLUSIA AVE STE 203
Mailing Address - Street 2:
Mailing Address - City:ORANGE CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32763-7047
Mailing Address - Country:US
Mailing Address - Phone:386-218-6335
Mailing Address - Fax:
Practice Address - Street 1:1495 S VOLUSIA AVE STE 203
Practice Address - Street 2:
Practice Address - City:ORANGE CITY
Practice Address - State:FL
Practice Address - Zip Code:32763-7047
Practice Address - Country:US
Practice Address - Phone:386-218-6335
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-11-21
Last Update Date:2022-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9407152363LP0808X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily