Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363L00000X | Nurse Practitioner | APRN11016122 | FL |
NPI | 1003573072 |
---|---|
Provider Name | Kelli Monnin |
First Address | Fort Myers, FL 33916-2216 |
Second Address | Fort Myers, FL 33908-4156 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/11/2021 |
Last Update Date | 10/01/2022 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
APRN11016122 | APRN (01) | FL |