Provider Demographics
NPI:1700065257
Name:ELLIOTT, MONICA M (PA-C)
Entity Type:Individual
Prefix:
First Name:MONICA
Middle Name:M
Last Name:ELLIOTT
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 1:3300 S FISKE BLVD
Mailing Address - Street 2:
Mailing Address - City:ROCKLEDGE
Mailing Address - State:FL
Mailing Address - Zip Code:32955-4306
Mailing Address - Country:US
Mailing Address - Phone:321-268-5008
Mailing Address - Fax:321-951-7408
Practice Address - Street 1:603 N WASHINGTON AVE
Practice Address - Street 2:SUITE 101
Practice Address - City:TITUSVILLE
Practice Address - State:FL
Practice Address - Zip Code:32796
Practice Address - Country:US
Practice Address - Phone:321-268-5008
Practice Address - Fax:321-607-6690
Is Sole Proprietor?:No
Enumeration Date:2007-11-01
Last Update Date:2018-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA05295363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLPENDINGMedicaid
FLHV363XOtherMEDICARE