Healthcare Provider Details

I. General information

NPI: 1821044058
Provider Name (Legal Business Name): BRETA SUE MONROE ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 05/26/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7305 N. MILITARY TRAIL MEDICINE (111)
WEST PALM BEACH FL
33410
US

IV. Provider business mailing address

7305 N. MILITARY TRAIL MEDICINE (111)
WEST PALM BEACH FL
33410
US

V. Phone/Fax

Practice location:
  • Phone: 561-422-6650
  • Fax: 561-422-8708
Mailing address:
  • Phone: 561-422-6650
  • Fax: 561-422-8708

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License NumberARNP 3319202
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: