Healthcare Provider Details

I. General information

NPI: 1902132616
Provider Name (Legal Business Name): LYNDSAY D MONROE PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/30/2009
Last Update Date: 05/27/2022
Certification Date: 05/10/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8000 SR 64 E
BRADENTON FL
34212
US

IV. Provider business mailing address

8000 SR 64 E
BRADENTON FL
34212
US

V. Phone/Fax

Practice location:
  • Phone: 941-792-1404
  • Fax: 941-761-0712
Mailing address:
  • Phone: 941-792-1404
  • Fax: 941-761-0712

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA9105092
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: