Healthcare Provider Details

I. General information

NPI: 1316524879
Provider Name (Legal Business Name): SHON-TELL MONIQUE LAROCHELLE RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/29/2021
Last Update Date: 03/16/2022
Certification Date: 03/16/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3572 PARK ST
JACKSONVILLE FL
32205-7736
US

IV. Provider business mailing address

3572 PARK ST
JACKSONVILLE FL
32205-7736
US

V. Phone/Fax

Practice location:
  • Phone: 207-939-4328
  • Fax:
Mailing address:
  • Phone: 207-939-4328
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAPRN11016981
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License Number9475688
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: