Provider Demographics
NPI:1225013477
Name:MONTROSS, JEANNE D (PHD ARNP)
Entity Type:Individual
Prefix:DR
First Name:JEANNE
Middle Name:D
Last Name:MONTROSS
Suffix:
Gender:F
Credentials:PHD ARNP
Other - Prefix:
Other - First Name:JEANNE
Other - Middle Name:D
Other - Last Name:MONTROSS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:ARNP PA
Mailing Address - Street 1:14286 BEACH BLVD STE 19
Mailing Address - Street 2:#348
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32250-1568
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4240 STACEY RD E
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32250-2100
Practice Address - Country:US
Practice Address - Phone:904-223-1684
Practice Address - Fax:904-223-9177
Is Sole Proprietor?:No
Enumeration Date:2005-12-09
Last Update Date:2009-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP1157192363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
593546315OtherUNITED BEHAVIORAL
593546815OtherTRICARE
2004928OtherCIGNA
P00233697OtherMEDICARE RR
Y6677OtherBCBS
Y6677OtherBCBS
2004928OtherCIGNA