Provider Demographics
NPI:1447335831
Name:MOLITOR, LISA (ARNP)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:
Last Name:MOLITOR
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12221 SW 89TH ST
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32608-7296
Mailing Address - Country:US
Mailing Address - Phone:352-485-1133
Mailing Address - Fax:352-485-2927
Practice Address - Street 1:23320 N STATE ROAD 235
Practice Address - Street 2:
Practice Address - City:BROOKER
Practice Address - State:FL
Practice Address - Zip Code:32622-5266
Practice Address - Country:US
Practice Address - Phone:352-485-1133
Practice Address - Fax:352-485-2927
Is Sole Proprietor?:No
Enumeration Date:2006-10-26
Last Update Date:2011-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP1098452363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL301483500Medicaid
FLARNP1098452OtherSTATE IDENTIFICATION