Healthcare Provider Details

I. General information

NPI: 1720598915
Provider Name (Legal Business Name): MONICA PARCO MSN, FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/02/2017
Last Update Date: 04/17/2021
Certification Date: 04/17/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2703 N PONCE DE LEON BLVD
ST AUGUSTINE FL
32084-2603
US

IV. Provider business mailing address

2703 N PONCE DE LEON BLVD
ST AUGUSTINE FL
32084-2603
US

V. Phone/Fax

Practice location:
  • Phone: 904-824-2868
  • Fax:
Mailing address:
  • Phone: 904-824-2868
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number0024175319
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN11006653
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: