MEDICARE: MS. MONETTE PEAN ARNP

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	363L00000X	Nurse Practitioner	9183719	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1205346715
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. MONETTE PEAN ARNP

Provider Business Mailing Address
First Line	:	3990 NW 51ST AVE
Second Line	:
City	:	LAUDERDALE LAKES
State	:	FL
Zip	:	33319-6534
Country	:	US
Telephone Number	:	954-682-8112
Fax Number	:

Provider Business Practice Location Address
First Line	:	818 S DIXIE HWY
Second Line	:
City	:	LAKE WORTH
State	:	FL
Zip	:	33460-5042
Country	:	US
Telephone Number	:	561-296-4400
Fax Number	:

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

Provider Enumeration Date	:	10/10/2017
Last Update Date	:	08/29/2022

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