Provider Demographics
NPI:1871818294
Name:MONTAS, ALEJANDRINA (PA)
Entity Type:Individual
Prefix:
First Name:ALEJANDRINA
Middle Name:
Last Name:MONTAS
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:ALEJANDRINA
Other - Middle Name:
Other - Last Name:MONTAS ENCARNACION
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PA
Mailing Address - Street 1:8360 SIERRA MEADOWS BLVD
Mailing Address - Street 2:
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34113-7328
Mailing Address - Country:US
Mailing Address - Phone:239-624-8500
Mailing Address - Fax:239-624-8501
Practice Address - Street 1:8360 SIERRA MEADOWS BLVD
Practice Address - Street 2:
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34113-7328
Practice Address - Country:US
Practice Address - Phone:239-624-8500
Practice Address - Fax:239-624-8501
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-29
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9105365363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL008743200Medicaid
FLDC702YOtherMEDICARE
FLY0H8POtherBCBS