=====================================================
General NPI Number Information
=====================================================
NPI Number | 1144292913
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MONICA LYNN MCPHAIL-PRUITT MD
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/06/2006
-----------------------------------------------------
Last Update Date | 03/13/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 6903 W COLONIAL DR
-----------------------------------------------------
City | ORLANDO
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32818-6829
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 407-298-9900
-----------------------------------------------------
Fax | 407-298-9920
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2401 FRIST BLVD #7, 9 & 10
-----------------------------------------------------
City | FORT PIERCE
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 34950-4800
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 772-466-0088
-----------------------------------------------------
Fax | 772-460-8555
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207LP2900X
-----------------------------------------------------
Taxonomy Name | Pain Medicine (Anesthesiology) Physician
-----------------------------------------------------
License Number | ME88069
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------