Provider Demographics
NPI:1164143517
Name:MONTES DE OCA, JOE (NP)
Entity Type:Individual
Prefix:
First Name:JOE
Middle Name:
Last Name:MONTES DE OCA
Suffix:
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11650 ALPHARETTA HWY STE 100
Mailing Address - Street 2:
Mailing Address - City:ROSWELL
Mailing Address - State:GA
Mailing Address - Zip Code:30076-3805
Mailing Address - Country:US
Mailing Address - Phone:404-596-5670
Mailing Address - Fax:404-334-0479
Practice Address - Street 1:11650 ALPHARETTA HWY STE 100
Practice Address - Street 2:
Practice Address - City:ROSWELL
Practice Address - State:GA
Practice Address - Zip Code:30076-3805
Practice Address - Country:US
Practice Address - Phone:404-596-5670
Practice Address - Fax:404-334-0479
Is Sole Proprietor?:No
Enumeration Date:2022-09-05
Last Update Date:2022-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN302741163W00000X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
GARN302741OtherRN LICENSE