Healthcare Provider Details

I. General information

NPI: 1487014478
Provider Name (Legal Business Name): MONICA RAE RORTVEDT PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MONICA RAE TRAYLOR

II. Dates (important events)

Enumeration Date: 03/03/2016
Last Update Date: 05/08/2026
Certification Date: 05/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1400 N US HIGHWAY 441 STE 810
LADY LAKE FL
32159-8987
US

IV. Provider business mailing address

6101 BLUE LAGOON DR STE 200
MIAMI FL
33126-3168
US

V. Phone/Fax

Practice location:
  • Phone: 352-750-2108
  • Fax: 352-750-1836
Mailing address:
  • Phone: 844-630-0700
  • Fax: 877-374-1924

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA9109388
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: