Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Molly Wallis, APRNFNP-C

Individual provider Family Nurse Practitioner · NPI 1053157123

Molly Wallis, APRNFNP-C is a Nurse Practitioner in Daytona Beach, Florida. Qualified in 2024, 2 years ago. Practices with Lakeside Endocrine Associates Inc, a 4-clinician group and accepts Medicare assignment. Licensed in Florida.

Years since qualifying
2
Licensed in
FL
In the registry since
2024
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Practice location Address checks out

1667 N Clyde Morris Blvd Ste 2
Daytona Beach, FL 32117-5500
Phone: (386) 274-1414
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Family Nurse Practitioner (primary) Taxonomy 363LF0000X · Licence APRN11033449 (FL)

Record details

NPI number1053157123
Entity typeIndividual (Type 1)
GenderFemale
Credentials APRNFNP-C
Sole proprietorNo
NPI enumeratedJuly 8, 2024
Last updated in NPPESFebruary 28, 2025
Certification dateFebruary 28, 2025

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyNURSE PRACTITIONER
Medical schoolOTHER
Graduated 2024 (2 years in practice)
Group practice Lakeside Endocrine Associates Inc — 4 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount

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