Provider Demographics
NPI:1760886972
Name:MOLUMBY, CASEY LEE (ARNP)
Entity Type:Individual
Prefix:MRS
First Name:CASEY
Middle Name:LEE
Last Name:MOLUMBY
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:MS
Other - First Name:CASEY
Other - Middle Name:LEE
Other - Last Name:PASS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:2080 CHILD ST BLDG 964
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32214-5005
Mailing Address - Country:US
Mailing Address - Phone:904-546-7090
Mailing Address - Fax:
Practice Address - Street 1:2080 CHILD ST BLDG 964
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32214-5005
Practice Address - Country:US
Practice Address - Phone:904-546-7090
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-17
Last Update Date:2021-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9203695363LA2200X, 363LX0106X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363LX0106XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerOccupational Health