Healthcare Provider Details

I. General information

NPI: 1790261501
Provider Name (Legal Business Name): MS. ZHYRMA ANGELICA MONZON CANALES
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/15/2018
Last Update Date: 06/15/2026
Certification Date: 06/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1599 TROPICAL CT STE 8
TAVARES FL
32778-4323
US

IV. Provider business mailing address

PO BOX 96674
PHOENIX AZ
85072-6674
US

V. Phone/Fax

Practice location:
  • Phone: 650-814-4524
  • Fax:
Mailing address:
  • Phone: 650-814-4524
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number9436655
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number9436655
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: