MEDICARE: JASMINE MONTANEZ APRN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	APRN11020150	FL
2	363L00000X	Nurse Practitioner	APRN11020150	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	WG065	OTHER	FL	HFMG

General Provider Information

NPI Number	:	1023748803
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JASMINE MONTANEZ APRN

Provider Business Mailing Address
First Line	:	3300 S FISKE BLVD
Second Line	:
City	:	ROCKLEDGE
State	:	FL
Zip	:	32955-4306
Country	:	US
Telephone Number	:	321-312-3328
Fax Number	:

Provider Business Practice Location Address
First Line	:	1223 GATEWAY DR
Second Line	:
City	:	MELBOURNE
State	:	FL
Zip	:	32901-2607
Country	:	US
Telephone Number	:	321-312-3328
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/14/2022
Last Update Date	:	12/09/2025

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Directions to “ JASMINE MONTANEZ APRN” Practice Location

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