Provider Demographics
NPI:1679095350
Name:MONTES, JEAN RHADENIE HERNANDEZ (FNP-C)
Entity Type:Individual
Prefix:MISS
First Name:JEAN RHADENIE
Middle Name:HERNANDEZ
Last Name:MONTES
Suffix:
Gender:F
Credentials:FNP-C
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Mailing Address - Street 1:1580 SANTA BARBARA BLVD
Mailing Address - Street 2:
Mailing Address - City:THE VILLAGES
Mailing Address - State:FL
Mailing Address - Zip Code:32159-6827
Mailing Address - Country:US
Mailing Address - Phone:352-259-2159
Mailing Address - Fax:352-259-5731
Practice Address - Street 1:3300 E SOUTH ST STE 305
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:CA
Practice Address - Zip Code:90805-4595
Practice Address - Country:US
Practice Address - Phone:
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-07-13
Last Update Date:2022-08-15
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA95005912207QA0505X
FLAPRN11016885207QA0505X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA95005912OtherCA BRN