Provider Demographics
NPI:1205071479
Name:ROGERS, MONIQUE JEANNETTE (AP, DOM)
Entity type:Individual
Prefix:
First Name:MONIQUE
Middle Name:JEANNETTE
Last Name:ROGERS
Suffix:
Gender:F
Credentials:AP, DOM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:143 EASTERN FRK
Mailing Address - Street 2:
Mailing Address - City:LONGWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:32750-2753
Mailing Address - Country:US
Mailing Address - Phone:407-701-7841
Mailing Address - Fax:
Practice Address - Street 1:499 E CENTRAL PKWY
Practice Address - Street 2:SUITE # 215
Practice Address - City:ALTAMONTE SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:32701-3402
Practice Address - Country:US
Practice Address - Phone:407-701-7841
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-02
Last Update Date:2008-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAP1781171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist