Provider Demographics
NPI:1649924580
Name:MONROE, C'AIRA CHANTELL (CPT)
Entity type:Individual
Prefix:
First Name:C'AIRA
Middle Name:CHANTELL
Last Name:MONROE
Suffix:
Gender:F
Credentials:CPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4720 SALISBURY RD
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32256-6101
Mailing Address - Country:US
Mailing Address - Phone:904-441-5475
Mailing Address - Fax:
Practice Address - Street 1:4720 SALISBURY RD
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32256-6101
Practice Address - Country:US
Practice Address - Phone:904-441-5475
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-09
Last Update Date:2022-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL13076-162-118-9045374700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes374700000XNursing Service Related ProvidersTechnicianGroup - Multi-Specialty