Provider Demographics
NPI:1407647423
Name:MOLINA, JOLIE ALYSSA DICKEY
Entity type:Individual
Prefix:
First Name:JOLIE
Middle Name:ALYSSA DICKEY
Last Name:MOLINA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:JOLIE
Other - Middle Name:ALYSSA
Other - Last Name:DICKEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1240 CECIL AVE
Mailing Address - Street 2:
Mailing Address - City:DELAND
Mailing Address - State:FL
Mailing Address - Zip Code:32720-8400
Mailing Address - Country:US
Mailing Address - Phone:386-747-7364
Mailing Address - Fax:
Practice Address - Street 1:1251 N STONE ST
Practice Address - Street 2:
Practice Address - City:DELAND
Practice Address - State:FL
Practice Address - Zip Code:32720-2584
Practice Address - Country:US
Practice Address - Phone:386-236-1781
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-05-16
Last Update Date:2025-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program