Provider Demographics
NPI:1659933737
Name:MONTANEZ DE JULIO, JENYCCE (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:JENYCCE
Middle Name:
Last Name:MONTANEZ DE JULIO
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:JENYCCE
Other - Middle Name:
Other - Last Name:MONTANEZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2755 NW 115TH TER
Mailing Address - Street 2:
Mailing Address - City:CORAL SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:33065-3435
Mailing Address - Country:US
Mailing Address - Phone:305-525-9489
Mailing Address - Fax:
Practice Address - Street 1:2414 E SUNRISE BLVD # 2140A
Practice Address - Street 2:
Practice Address - City:FT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33304-3102
Practice Address - Country:US
Practice Address - Phone:954-561-6244
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-28
Last Update Date:2019-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9111948363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant