Provider Demographics
NPI:1790265031
Name:MONROE, JENNIFER RUTH
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:RUTH
Last Name:MONROE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13831 LAKE MAHOGANY BLVD APT 3722
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33907-6603
Mailing Address - Country:US
Mailing Address - Phone:239-823-6786
Mailing Address - Fax:
Practice Address - Street 1:1550 BARKLEY CIR
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33907-4539
Practice Address - Country:US
Practice Address - Phone:239-938-2000
Practice Address - Fax:239-278-0404
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-16
Last Update Date:2018-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9186092363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily