Provider Demographics
NPI:1104635424
Name:WILKINSON, MOLLY JANE (NP)
Entity type:Individual
Prefix:
First Name:MOLLY
Middle Name:JANE
Last Name:WILKINSON
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:MOLLY
Other - Middle Name:JANE
Other - Last Name:PRICE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1965 COUNTY ROAD 243C
Mailing Address - Street 2:
Mailing Address - City:WILDWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:34785-7405
Mailing Address - Country:US
Mailing Address - Phone:352-586-8303
Mailing Address - Fax:
Practice Address - Street 1:1965 COUNTY ROAD 243C
Practice Address - Street 2:
Practice Address - City:WILDWOOD
Practice Address - State:FL
Practice Address - Zip Code:34785-7405
Practice Address - Country:US
Practice Address - Phone:352-586-8303
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-01-01
Last Update Date:2025-01-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN11036940363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner