Healthcare Provider Details

I. General information

NPI: 1477855005
Provider Name (Legal Business Name): NATHALIE MONUMA ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/02/2010
Last Update Date: 12/06/2023
Certification Date: 12/04/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2002 SW 84TH TERRACE
NORTH LAUDERDALE FL
33068-4751
US

IV. Provider business mailing address

2002 SW 84TH TERRACE
NORTH LAUDERDALE FL
33068-4751
US

V. Phone/Fax

Practice location:
  • Phone: 305-889-9421
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberARNP9207353
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberARNP9207353
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: