Provider Demographics
NPI:1578915070
Name:LEBRON MONCLOVA, LUZ MEDY (RN)
Entity Type:Individual
Prefix:
First Name:LUZ
Middle Name:MEDY
Last Name:LEBRON MONCLOVA
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5681 EDENFIELD RD
Mailing Address - Street 2:APT. 1005
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32277-1469
Mailing Address - Country:US
Mailing Address - Phone:904-314-9156
Mailing Address - Fax:
Practice Address - Street 1:5681 EDENFIELD RD
Practice Address - Street 2:APT. 1005
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32277-1469
Practice Address - Country:US
Practice Address - Phone:904-314-9156
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-07-07
Last Update Date:2016-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRN9227949376G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376G00000XNursing Service Related ProvidersNursing Home Administrator