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NPI Code Detail

MEDICARE: JEANNE D MONTROSS ARNP PA

MEDICARE: JEANNE D MONTROSS ARNP PA
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
1364SP0808XPsychiatric/Mental Health Clinical Nurse Specialist1157192FL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
2Y6677OTHERFLBC/BS
32004928OTHERFLCIGNA

General Provider Information

NPI Number : 1184889719
Entity Type Code : Organization
Provider Name (Legal Business Name) : JEANNE D MONTROSS ARNP PA
Provider Business Mailing Address
First Line : 14286 BEACH BLVD STE 19
Second Line : #348
City : JACKSONVILLE
State : FL
Zip : 32250-1568
Country : US
Telephone Number : 904-223-1684
Fax Number : 904-223-9177
Provider Business Practice Location Address
First Line : 4240 STACEY RD E
Second Line :
City : JACKSONVILLE
State : FL
Zip : 32250-2100
Country : US
Telephone Number : 904-223-1684
Fax Number : 904-223-9177
Authorized Official
Title or Position : VICE PRESIDENT
Name : CATHERINE RYBICKI
Credential :
Telephone Number : 904-223-1684
Provider Enumeration Date : 07/23/2008
Last Update Date : 03/19/2009

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