Provider Demographics
NPI:1396188058
Name:MASTERSON, MONICA (ACNPC-AG)
Entity Type:Individual
Prefix:
First Name:MONICA
Middle Name:
Last Name:MASTERSON
Suffix:
Gender:F
Credentials:ACNPC-AG
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14101 MARQUESAS WAY APT 4419
Mailing Address - Street 2:
Mailing Address - City:MARINA DEL REY
Mailing Address - State:CA
Mailing Address - Zip Code:90292-7463
Mailing Address - Country:US
Mailing Address - Phone:615-957-3350
Mailing Address - Fax:
Practice Address - Street 1:MCN AA1204
Practice Address - Street 2:1161 21ST AVENUE SOUTH
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37232-0001
Practice Address - Country:US
Practice Address - Phone:615-343-1465
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-04-12
Last Update Date:2023-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95022485363LA2100X
TN17342363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care