Provider Demographics
NPI:1922562834
Name:TORRES, MONIQUE (PA-C)
Entity Type:Individual
Prefix:
First Name:MONIQUE
Middle Name:
Last Name:TORRES
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:46 TILDEN HOWINGTON DR
Mailing Address - Street 2:
Mailing Address - City:LILLINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:27546-5659
Mailing Address - Country:US
Mailing Address - Phone:910-494-7856
Mailing Address - Fax:
Practice Address - Street 1:130 PINE STATE ST STE C
Practice Address - Street 2:
Practice Address - City:LILLINGTON
Practice Address - State:NC
Practice Address - Zip Code:27546-9414
Practice Address - Country:US
Practice Address - Phone:910-474-0050
Practice Address - Fax:863-228-8484
Is Sole Proprietor?:No
Enumeration Date:2019-01-24
Last Update Date:2021-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC363A00000X
NC0010-08851207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine