Provider Demographics
NPI:1487244083
Name:MONTOJO-WEISS, ROWENA GAER
Entity type:Individual
Prefix:
First Name:ROWENA
Middle Name:GAER
Last Name:MONTOJO-WEISS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:736 CANNA DR
Mailing Address - Street 2:
Mailing Address - City:DAVENPORT
Mailing Address - State:FL
Mailing Address - Zip Code:33897-3828
Mailing Address - Country:US
Mailing Address - Phone:407-219-8947
Mailing Address - Fax:
Practice Address - Street 1:1144 KELTON AVE
Practice Address - Street 2:
Practice Address - City:OCOEE
Practice Address - State:FL
Practice Address - Zip Code:34761-3175
Practice Address - Country:US
Practice Address - Phone:407-347-0571
Practice Address - Fax:407-347-0520
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-19
Last Update Date:2021-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLF12200110363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily