Healthcare Provider Details

I. General information

NPI: 1962007104
Provider Name (Legal Business Name): MONIQUE SHAWNTAYE CUTHBERTSON APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/04/2020
Last Update Date: 02/12/2021
Certification Date: 02/12/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 MAIN ST STE 203
SAFETY HARBOR FL
34695-3668
US

IV. Provider business mailing address

4310 METRO PKWY STE 205
FORT MYERS FL
33916-9416
US

V. Phone/Fax

Practice location:
  • Phone: 727-799-4150
  • Fax: 727-796-1845
Mailing address:
  • Phone: 239-236-8784
  • Fax: 239-790-2624

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAPRN11010304
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: