Healthcare Provider Details

I. General information

NPI: 1689117657
Provider Name (Legal Business Name): EMILY R MONAHAN PA-C, ATC, OTC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/23/2016
Last Update Date: 04/12/2023
Certification Date: 04/12/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2727 W DR MARTIN LUTHER KING JR BLVD SUITE 320
TAMPA FL
33607-6383
US

IV. Provider business mailing address

2727 W DR MARTIN LUTHER KING JR BLVD STE 320
TAMPA FL
33607-6055
US

V. Phone/Fax

Practice location:
  • Phone: 813-877-6748
  • Fax: 813-875-0359
Mailing address:
  • Phone: 813-877-6748
  • Fax: 813-875-0359

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code246Z00000X
TaxonomyOther Specialist/Technologist
License NumberAL 3279
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License NumberPA9110070
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: