Provider Demographics
NPI:1487014478
Name:TRAYLOR, MONICA RAE (PA-C)
Entity Type:Individual
Prefix:MISS
First Name:MONICA
Middle Name:RAE
Last Name:TRAYLOR
Suffix:
Gender:F
Credentials:PA-C
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Mailing Address - Street 1:6041 SW 54TH ST STE 200
Mailing Address - Street 2:
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34474-5521
Mailing Address - Country:US
Mailing Address - Phone:352-857-8417
Mailing Address - Fax:352-877-2083
Practice Address - Street 1:2910 BROWNWOOD BLVD
Practice Address - Street 2:
Practice Address - City:THE VILLAGES
Practice Address - State:FL
Practice Address - Zip Code:32163-2032
Practice Address - Country:US
Practice Address - Phone:352-674-1790
Practice Address - Fax:352-674-8990
Is Sole Proprietor?:No
Enumeration Date:2016-03-03
Last Update Date:2021-05-03
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
FLPA9109388363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL106912100Medicaid
FL0D4ZEOtherFLORIDA BLUE
FL5297418OtherCIGNA