Provider Demographics
NPI:1831291673
Name:GODAR-MOLLICA, LYNN E (APRN)
Entity Type:Individual
Prefix:MRS
First Name:LYNN
Middle Name:E
Last Name:GODAR-MOLLICA
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:63 COLONY RD
Mailing Address - Street 2:
Mailing Address - City:JUPITER
Mailing Address - State:FL
Mailing Address - Zip Code:33469-3507
Mailing Address - Country:US
Mailing Address - Phone:561-246-1862
Mailing Address - Fax:
Practice Address - Street 1:63 COLONY RD
Practice Address - Street 2:
Practice Address - City:JUPITER
Practice Address - State:FL
Practice Address - Zip Code:33469-3507
Practice Address - Country:US
Practice Address - Phone:561-246-1862
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-02
Last Update Date:2012-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9313160363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT500001888Medicare UPIN
TX8L3819Medicare PIN