Individual provider Active NPI

Molly Anne Nicholas, ARNP

  • Nurse Practitioner
  • Melrose, FL
National Provider Identifier
1629097555
Registry record updated Oct 30, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
License
ARNP3048822 Issued in FL
Practice address
5818 Centre St
Melrose, FL 32666-6207
Phone
(352) 475-3792
Fax
(352) 475-3794
NPI assigned
Jul 19, 2006
Last updated
Oct 30, 2018By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 30, 2018

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Nurse Practitioner 363L00000X ARNP3048822 FL Primary

Addresses

Primary practice location

5818 Centre St
Melrose, FL 32666-6207

Mailing address

8117 SW 12TH PL
Gainesville, FL 32607-3329
Phone (352) 317-6361

Other identifiers 2

IdentifierTypeStateIssuer
306300300MedicaidFL
11711668OtherCAQH

Other names 1

  • Molly Nicholas Knisley Former name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20070117000485 FL Practitioner - Nurse Practitioner 4688675689 Reassigns benefits to 2 organizations

National Provider Directory

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

Organizations & group practices 2

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.

NPI Registry JSON

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

{
    "created_epoch": "1153267200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1540857600000",
    "number": "1629097555",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8117 SW 12TH PL",
            "city": "GAINESVILLE",
            "state": "FL",
            "postal_code": "326073329",
            "telephone_number": "352-317-6361"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5818 CENTRE ST",
            "city": "MELROSE",
            "state": "FL",
            "postal_code": "326666207",
            "telephone_number": "352-475-3792",
            "fax_number": "352-475-3794"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NICHOLAS",
        "first_name": "MOLLY",
        "middle_name": "ANNE",
        "name_prefix": "Ms.",
        "credential": "ARNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-07-19",
        "last_updated": "2018-10-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "FL",
            "license": "ARNP3048822",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "306300300",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CAQH",
            "identifier": "11711668",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "MOLLY",
            "last_name": "KNISLEY",
            "middle_name": "NICHOLAS",
            "credential": "ARNP",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Melrose, FL

Sources for this page

Verify at the official NPI Registry.