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General NPI Number Information
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NPI Number | 1053808360
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Entity Type | Individual
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Provider Name | MONET JENIECE DACIUS APRN
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Gender | Female
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Dates
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Enumeration Date | 04/23/2018
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Last Update Date | 10/18/2024
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Provider Practice Location Address
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Address Line | 4655 SALISBURY RD STE 220
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City | JACKSONVILLE
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State | FL
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Zip | 32256-0959
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Country | US
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Telephone | 904-570-9404
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Fax | 904-900-2224
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Provider Business Mailing Address
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Address Line | 10129 BEDFORD LAKES CT
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City | JACKSONVILLE
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State | FL
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Zip | 32222-4119
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Country | US
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Telephone | 904-742-9416
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 9338936
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 9338936
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License Number State | FL
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