Provider Demographics
NPI:1508517715
Name:MAYES, MONICA PARDO (APRN)
Entity Type:Individual
Prefix:
First Name:MONICA
Middle Name:PARDO
Last Name:MAYES
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:MONICA
Other - Middle Name:
Other - Last Name:PARDO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4471 ELLIPSE DR
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32246-7451
Mailing Address - Country:US
Mailing Address - Phone:561-876-8532
Mailing Address - Fax:
Practice Address - Street 1:7406 FULLERTON ST
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32256-3552
Practice Address - Country:US
Practice Address - Phone:561-876-8532
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-10
Last Update Date:2022-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11016603363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily