Provider Demographics
NPI:1629672126
Name:DE VITO, MONIQUE LAMBERT-BAKER (APRN)
Entity Type:Individual
Prefix:MS
First Name:MONIQUE
Middle Name:LAMBERT-BAKER
Last Name:DE VITO
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:MS
Other - First Name:MONIQUE
Other - Middle Name:
Other - Last Name:HAYEZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APRN
Mailing Address - Street 1:PO BOX 161186
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33116-1186
Mailing Address - Country:US
Mailing Address - Phone:786-371-5552
Mailing Address - Fax:
Practice Address - Street 1:8900 N KENDALL DR
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33176-2118
Practice Address - Country:US
Practice Address - Phone:786-596-1960
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-24
Last Update Date:2020-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11003244363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty