Healthcare Provider Details

I. General information

NPI: 1740111863
Provider Name (Legal Business Name): NICHOLAS MONCALEANO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/27/2026
Last Update Date: 09/21/2026
Certification Date: 09/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5151 N 9TH AVE
PENSACOLA FL
32504-8721
US

IV. Provider business mailing address

30759 MARCEL BLVD
SPANISH FORT AL
36527-6046
US

V. Phone/Fax

Practice location:
  • Phone: 855-768-6363
  • Fax:
Mailing address:
  • Phone: 225-253-2634
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberAPRN11050240
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: