Healthcare Provider Details

I. General information

NPI: 1538679113
Provider Name (Legal Business Name): MONICA LEE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/09/2017
Last Update Date: 04/08/2024
Certification Date: 04/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1735 N TREASURE DR
NORTH BAY VILLAGE FL
33141-4216
US

IV. Provider business mailing address

PO BOX 735706
CHICAGO IL
60673-1164
US

V. Phone/Fax

Practice location:
  • Phone: 305-865-2383
  • Fax:
Mailing address:
  • Phone: 786-252-2770
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number9280567
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: