NPIMap

Individual provider Active NPI

Molly Wallis, APRN FNP-C

  • Family Nurse Practitioner
  • Daytona Beach, FL
National Provider Identifier
1053157123
Registry record updated Feb 28, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
APRN11033449 Issued in FL
Practice address
1667 N Clyde Morris Blvd Ste 2
Daytona Beach, FL 32117-5500
Phone
(386) 274-1414
NPI assigned
Jul 8, 2024
Last updated
Feb 28, 2025By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 28, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X APRN11033449 FL Primary

Addresses

Primary practice location

1667 N Clyde Morris Blvd Ste 2
Daytona Beach, FL 32117-5500

Mailing address

137 Heathrow Dr
Daytona Beach, FL 32117-3831
Phone (386) 795-2756

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20241114003940 FL Practitioner - Nurse Practitioner 8224562137 Reassigns benefits to 4 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2024
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Lakeside Endocrine Associates IncGroup PAC ID 9133408008, 4 clinicians

Practice addresses (Care Compare)

1667 N Clyde Morris Blvd
Suite 2
Daytona Beach, FL 32117-5500
Phone (386) 274-1414

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
APRN11033449FLMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Abode Care Partners Al VB, LLC CurrentSince Sep 1, 2024 Accepting new patients
Abode Care Partners Al VB, LLC CurrentSince Sep 1, 2024 Accepting new patients
Abode Care Partners LTC VB, LLC CurrentSince Sep 5, 2024 Accepting new patients
Vera Endocrine Associates Inc CurrentSince Mar 11, 2025 Accepting new patients
SHC Medical Partners of Florida, LLC CurrentSince Sep 13, 2024 Accepting new patients
Lakeside Endocrine Associates, Inc CurrentSince Mar 24, 2025 Accepting new patients
Abode Care Partners LTC VB, LLC CurrentSince Sep 5, 2024 Accepting new patients

Locations

1667 N Clyde Morris Blvd
#2
Daytona Beach, FL 32117
Phone (386) 274-1414

4400 Bayou Blvd
Ste 54A
Pensacola, FL 32503
Phone (727) 323-3611

4033 Beaver Ln
Pt Charlotte, FL 33952
Phone (941) 212-2748

12201 Bluegrass Pkwy
Louisville, KY 40299
Phone (502) 568-7364

805 N Whittington Pkwy
Ste 400
Louisville, KY 40222
Phone (502) 272-3438

805 N Whittington Pkwy
Northfield, KY 40222
Phone (502) 627-7000

Networks

  • Optimum HealthCare HMO Network
  • Freedom Health HMO Network

Interoperability endpoints

  • FHIR API: https://api.platform.athenahealth.com/12862/brand/1/csg/1/fhir/r4
  • Direct secure messaging: molly.wallis.1@12862.direct.athenahealth.com

Organizations & group practices 7

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 5

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1720396800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1740700800000",
    "number": "1053157123",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "137 HEATHROW DR",
            "city": "DAYTONA BEACH",
            "state": "FL",
            "postal_code": "321173831",
            "telephone_number": "386-795-2756"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1667 N CLYDE MORRIS BLVD STE 2",
            "city": "DAYTONA BEACH",
            "state": "FL",
            "postal_code": "321175500",
            "telephone_number": "386-274-1414"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALLIS",
        "first_name": "MOLLY",
        "credential": "APRN FNP-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2024-07-08",
        "last_updated": "2025-02-28",
        "certification_date": "2025-02-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "FL",
            "license": "APRN11033449",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Daytona Beach, FL

Sources for this page

Verify at the official NPI Registry.