MEDICARE: JHONNY MONTOYA MANOSALVA NP

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	APRN11036425	FL

General Provider Information

NPI Number	:	1821823014
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JHONNY MONTOYA MANOSALVA NP

Provider Business Mailing Address
First Line	:	8615 COMMODITY CIR STE 17
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32819-9072
Country	:	US
Telephone Number	:	407-707-1814
Fax Number	:	386-401-1898

Provider Business Practice Location Address
First Line	:	1642 N VOLUSIA AVE
Second Line	:
City	:	ORANGE CITY
State	:	FL
Zip	:	32763-3842
Country	:	US
Telephone Number	:	386-774-0188
Fax Number	:	386-774-1327

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

Provider Enumeration Date	:	09/05/2024
Last Update Date	:	04/08/2026

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