Provider Demographics
NPI:1558403253
Name:MONROE, KATHY JEAN (APRN)
Entity Type:Individual
Prefix:
First Name:KATHY
Middle Name:JEAN
Last Name:MONROE
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:KATHY
Other - Middle Name:JEAN
Other - Last Name:FORTH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:11706 TAMPA GATEWAY BLVD
Mailing Address - Street 2:
Mailing Address - City:SEFFNER
Mailing Address - State:FL
Mailing Address - Zip Code:33584-3038
Mailing Address - Country:US
Mailing Address - Phone:813-626-3926
Mailing Address - Fax:813-626-3938
Practice Address - Street 1:11706 TAMPA GATEWAY BLVD
Practice Address - Street 2:
Practice Address - City:SEFFNER
Practice Address - State:FL
Practice Address - Zip Code:33584-3038
Practice Address - Country:US
Practice Address - Phone:813-626-3926
Practice Address - Fax:813-626-3938
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-12
Last Update Date:2020-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX720905363LA2200X
FLAPRN9333500363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLY0J94OtherBCBS
FL009196200Medicaid
FLHM986WOtherRR MCR
FL009196200Medicaid