Provider Demographics
NPI:1376575209
Name:ANTLEY, MONA LYNN GOLDEN (APRN)
Entity Type:Individual
Prefix:MRS
First Name:MONA
Middle Name:LYNN GOLDEN
Last Name:ANTLEY
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1205 MARION AVE
Mailing Address - Street 2:
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32303-6513
Mailing Address - Country:US
Mailing Address - Phone:850-681-3887
Mailing Address - Fax:850-681-0569
Practice Address - Street 1:1205 MARION AVE
Practice Address - Street 2:
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32303-6513
Practice Address - Country:US
Practice Address - Phone:850-681-3887
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-07
Last Update Date:2018-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN1917052363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL301985300Medicaid