Provider Demographics
NPI:1184889719
Name:JEANNE D MONTROSS ARNP PA
Entity type:Organization
Organization Name:JEANNE D MONTROSS ARNP PA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CATHERINE
Authorized Official - Middle Name:
Authorized Official - Last Name:RYBICKI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:904-223-1684
Mailing Address - Street 1:14286 BEACH BLVD STE 19
Mailing Address - Street 2:#348
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32250-1568
Mailing Address - Country:US
Mailing Address - Phone:904-223-1684
Mailing Address - Fax:904-223-9177
Practice Address - Street 1:4240 STACEY RD E
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32250-2100
Practice Address - Country:US
Practice Address - Phone:904-223-1684
Practice Address - Fax:904-223-9177
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:JEANNE D MONTROSS ARNP PA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-07-23
Last Update Date:2009-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1157192364SP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes364SP0808XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental HealthGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLPO0233697OtherMEDICARE RR
FLY6677OtherBC/BS
FL2004928OtherCIGNA
FL2004928OtherCIGNA
FLY6677OtherBC/BS