Healthcare Provider Details

I. General information

NPI: 1437324670
Provider Name (Legal Business Name): MONICA WISE ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/29/2008
Last Update Date: 02/18/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

675 S BABCOCK ST
MELBOURNE FL
32901
US

IV. Provider business mailing address

675 S BABCOCK ST
MELBOURNE FL
32901-1459
US

V. Phone/Fax

Practice location:
  • Phone: 321-951-1010
  • Fax: 321-952-4038
Mailing address:
  • Phone: 321-951-1010
  • Fax: 321-951-1010

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberARNP3329362
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: