Provider Demographics
NPI:1235123654
Name:TERCERO, MONICA DENISE (RNNP)
Entity Type:Individual
Prefix:MRS
First Name:MONICA
Middle Name:DENISE
Last Name:TERCERO
Suffix:
Gender:F
Credentials:RNNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:256 INTERNATIONAL CIRCLE
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95119
Mailing Address - Country:US
Mailing Address - Phone:408-360-6868
Mailing Address - Fax:
Practice Address - Street 1:256 INTERNATIONAL CIRCLE
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95119-0000
Practice Address - Country:US
Practice Address - Phone:408-360-6868
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-31
Last Update Date:2016-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARN321535363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAP18351/ZZZ19375ZMedicare UPIN