Active NPI
Melanie Wendt Molligan, PA-C
- Physician Assistant
- Tampa, FL
National Provider Identifier
1265701015
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- License
- PA9106274
- Practice address
- 13330 Usf Laurel Dr
Tampa, FL 33612-6601 - Phone
- (813) 974-2201
- NPI assigned
- Dec 23, 2011
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | PA9106274 | FL | Primary |
Addresses
Primary practice location
13330 Usf Laurel Dr
Tampa, FL 33612-6601
Mailing address
PO Box 917770
Orlando, FL 32891-7770
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 010519400 | Medicaid | FL | |
| Y0AR5 | Other | FL | BLUE CROSS BLUE SHIELD |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PA9106274 | FL | MD | Physician Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1324598400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1444608000000",
"number": "1265701015",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 917770",
"city": "ORLANDO",
"state": "FL",
"postal_code": "328917770"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "13330 USF LAUREL DR",
"city": "TAMPA",
"state": "FL",
"postal_code": "336126601",
"telephone_number": "813-974-2201"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MOLLIGAN",
"first_name": "MELANIE",
"middle_name": "WENDT",
"name_prefix": "Ms.",
"credential": "PA-C",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2011-12-23",
"last_updated": "2015-10-12",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "FL",
"license": "PA9106274",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "010519400",
"state": "FL"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE CROSS BLUE SHIELD",
"identifier": "Y0AR5",
"state": "FL"
}
],
"endpoints": [],
"other_names": []
}Other providers in Tampa, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 12, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.