Provider Demographics
NPI:1174984132
Name:MONACO, JEANNE LORRAINE (CPNP, ARNP)
Entity type:Individual
Prefix:
First Name:JEANNE
Middle Name:LORRAINE
Last Name:MONACO
Suffix:
Gender:F
Credentials:CPNP, ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11246 SW 137TH AVE
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33186-4201
Mailing Address - Country:US
Mailing Address - Phone:305-382-0020
Mailing Address - Fax:305-383-2174
Practice Address - Street 1:11246 SW 137TH AVE
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33186-4201
Practice Address - Country:US
Practice Address - Phone:305-382-0020
Practice Address - Fax:305-383-2174
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-17
Last Update Date:2016-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1373352261QP2300X, 363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
No261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care