Healthcare Provider Details

I. General information

NPI: 1154971349
Provider Name (Legal Business Name): HOLLY MONACO PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: HOLLY ROTHWEILER PA-C

II. Dates (important events)

Enumeration Date: 09/19/2019
Last Update Date: 05/15/2024
Certification Date: 05/15/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1569 MATTHEW DR
FORT MYERS FL
33907-1734
US

IV. Provider business mailing address

PO BOX 2147
FORT MYERS FL
33902-2147
US

V. Phone/Fax

Practice location:
  • Phone: 239-481-4111
  • Fax:
Mailing address:
  • Phone: 239-343-8220
  • Fax: 239-468-7909

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA9112555
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: