Provider Demographics
NPI:1689117657
Name:MONAHAN, EMILY R (PA-C, ATC, OTC)
Entity Type:Individual
Prefix:MS
First Name:EMILY
Middle Name:R
Last Name:MONAHAN
Suffix:
Gender:F
Credentials:PA-C, ATC, OTC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2727 W DR MARTIN LUTHER KING JR BLVD STE 320
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33607-6055
Mailing Address - Country:US
Mailing Address - Phone:813-877-6748
Mailing Address - Fax:813-875-0359
Practice Address - Street 1:2727 W DR MARTIN LUTHER KING JR BLVD
Practice Address - Street 2:SUITE 320
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33607-6383
Practice Address - Country:US
Practice Address - Phone:813-877-6748
Practice Address - Fax:813-875-0359
Is Sole Proprietor?:No
Enumeration Date:2016-11-23
Last Update Date:2023-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAL 3279246Z00000X
FLPA9110070363AS0400X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
No246Z00000XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, Other
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL020042700Medicaid
FL020042700Medicaid