Provider Demographics
NPI:1811614159
Name:PARKTON, MOLLY (APRN)
Entity type:Individual
Prefix:
First Name:MOLLY
Middle Name:
Last Name:PARKTON
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 1:49 DERBY DOWNS CIR
Mailing Address - Street 2:
Mailing Address - City:NICEVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32578-2749
Mailing Address - Country:US
Mailing Address - Phone:850-313-9464
Mailing Address - Fax:
Practice Address - Street 1:319 GREEN ACRES RD
Practice Address - Street 2:
Practice Address - City:FORT WALTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:32547-1170
Practice Address - Country:US
Practice Address - Phone:850-862-2385
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-10-27
Last Update Date:2022-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11022647363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology