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General NPI Number Information
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NPI Number | 1780425892
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Entity Type | Individual
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Provider Name | MONTE REVELL
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Gender | Female
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Dates
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Enumeration Date | 06/03/2024
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Last Update Date | 01/06/2025
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Provider Practice Location Address
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Address Line | 425 W 19TH ST STE D&E
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City | PANAMA CITY
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State | FL
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Zip | 32405-4659
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Country | US
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Telephone | 850-818-0220
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Fax | 850-818-0156
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Provider Business Mailing Address
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Address Line | PO BOX 13834
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City | TALLAHASSEE
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State | FL
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Zip | 32317-3834
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Country | US
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Telephone | 850-205-6232
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Fax | 855-975-0615
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number |
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License Number State |
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