Provider Demographics
NPI:1598545550
Name:MUSSARY, MOLLY ANN (PA-C)
Entity type:Individual
Prefix:
First Name:MOLLY
Middle Name:ANN
Last Name:MUSSARY
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3028 NW 29TH AVE
Mailing Address - Street 2:
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33434-6036
Mailing Address - Country:US
Mailing Address - Phone:561-400-0139
Mailing Address - Fax:
Practice Address - Street 1:1150 N 35TH AVE STE 395
Practice Address - Street 2:
Practice Address - City:HOLLYWOOD
Practice Address - State:FL
Practice Address - Zip Code:33021-5412
Practice Address - Country:US
Practice Address - Phone:954-987-5430
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-05
Last Update Date:2023-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9118008363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant