Provider Demographics
NPI:1124241096
Name:MOLINA, NIGEL (PA)
Entity type:Individual
Prefix:MR
First Name:NIGEL
Middle Name:
Last Name:MOLINA
Suffix:
Gender:M
Credentials:PA
Other - Prefix:MR
Other - First Name:NIGEL
Other - Middle Name:
Other - Last Name:MOLINA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PA
Mailing Address - Street 1:6343 SW 158TH AVE
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33193-3681
Mailing Address - Country:US
Mailing Address - Phone:305-386-4786
Mailing Address - Fax:
Practice Address - Street 1:1150 NW 72ND AVE
Practice Address - Street 2:SUITE 720
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33126-1936
Practice Address - Country:US
Practice Address - Phone:305-599-1990
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9100825363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical