MEDICARE: MONIQUE PRINCE FNP-C

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	11017729	FL

General Provider Information

NPI Number	:	1528349297
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MONIQUE PRINCE FNP-C

Provider Business Mailing Address
First Line	:	1850 PREVATT ST
Second Line	:
City	:	EUSTIS
State	:	FL
Zip	:	32726-6123
Country	:	US
Telephone Number	:	352-253-2511
Fax Number	:	352-253-2525

Provider Business Practice Location Address
First Line	:	1850 PREVATT ST
Second Line	:
City	:	EUSTIS
State	:	FL
Zip	:	32726-6123
Country	:	US
Telephone Number	:	352-253-2511
Fax Number	:	352-253-2511

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

Provider Enumeration Date	:	09/07/2011
Last Update Date	:	12/03/2025

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