Provider Demographics
NPI:1629004940
Name:MONTINIERI, MELISSA (NP)
Entity Type:Individual
Prefix:MS
First Name:MELISSA
Middle Name:
Last Name:MONTINIERI
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11241 MIROMAR SQUARE BLVD
Mailing Address - Street 2:
Mailing Address - City:ESTERO
Mailing Address - State:FL
Mailing Address - Zip Code:33928-6229
Mailing Address - Country:US
Mailing Address - Phone:860-209-4741
Mailing Address - Fax:
Practice Address - Street 1:11241 MIROMAR SQUARE BLVD
Practice Address - Street 2:
Practice Address - City:ESTERO
Practice Address - State:FL
Practice Address - Zip Code:33928-6229
Practice Address - Country:US
Practice Address - Phone:860-209-4741
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-26
Last Update Date:2019-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT069423363LF0000X
FLARNP9396068363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT500002270Medicare PIN
CT1629004940Medicare PIN