Provider Demographics
NPI:1265492136
Name:JELIC, MONIKA (NP)
Entity Type:Individual
Prefix:MS
First Name:MONIKA
Middle Name:
Last Name:JELIC
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:260 S BROAD ST
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19102-5021
Mailing Address - Country:US
Mailing Address - Phone:215-985-2500
Mailing Address - Fax:267-765-2325
Practice Address - Street 1:216 W SOMERSET ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19133-3534
Practice Address - Country:US
Practice Address - Phone:267-765-2272
Practice Address - Fax:215-426-5123
Is Sole Proprietor?:No
Enumeration Date:2006-03-24
Last Update Date:2013-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP009728363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics