MEDICARE: MRS. SHAWNTAVIA MONTERO FNP-BC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	APRN11028443	FL

General Provider Information

NPI Number	:	1902682503
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. SHAWNTAVIA MONTERO FNP-BC

Provider Business Mailing Address
First Line	:	1275 US HIGHWAY 1 STE 26011
Second Line	:
City	:	VERO BEACH
State	:	FL
Zip	:	32960-5783
Country	:	US
Telephone Number	:	954-253-6262
Fax Number	:

Provider Business Practice Location Address
First Line	:	1275 US HIGHWAY 1 STE 26011
Second Line	:
City	:	VERO BEACH
State	:	FL
Zip	:	32960-5783
Country	:	US
Telephone Number	:	954-253-6262
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/07/2023
Last Update Date	:	09/17/2023

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