Healthcare Provider Details

I. General information

NPI: 1174208367
Provider Name (Legal Business Name): MONICA JUNE BACH PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MONICA JUNE SCHUMACHER PA-C

II. Dates (important events)

Enumeration Date: 06/16/2023
Last Update Date: 10/01/2024
Certification Date: 10/01/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

661 E ALTAMONTE DR STE 222
ALTAMONTE SPRINGS FL
32701-5102
US

IV. Provider business mailing address

661 E ALTAMONTE DR STE 222
ALTAMONTE SPRINGS FL
32701-5102
US

V. Phone/Fax

Practice location:
  • Phone: 407-303-3081
  • Fax:
Mailing address:
  • Phone: 407-303-3081
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License NumberPA9117551
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA9117551
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: