Healthcare Provider Details

I. General information

NPI: 1073599098
Provider Name (Legal Business Name): CHRISTINE PALMER MONDAY NNP
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 12/21/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1700 S 23RD ST
FORT PIERCE FL
34950-4803
US

IV. Provider business mailing address

PO BOX 17540
PLANTATION FL
33318-7540
US

V. Phone/Fax

Practice location:
  • Phone: 772-461-4000
  • Fax:
Mailing address:
  • Phone: 954-838-2371
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LN0000X
TaxonomyNeonatal Nurse Practitioner
License NumberARNP3362612
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: