Provider Demographics
NPI:1750707360
Name:NUR, MONICA BEVERLY
Entity type:Individual
Prefix:MRS
First Name:MONICA
Middle Name:BEVERLY
Last Name:NUR
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:620 32ND AVE S
Mailing Address - Street 2:
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33705-7701
Mailing Address - Country:US
Mailing Address - Phone:727-824-5731
Mailing Address - Fax:727-824-5731
Practice Address - Street 1:620 32ND AVE S
Practice Address - Street 2:
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33705-7701
Practice Address - Country:US
Practice Address - Phone:727-824-5731
Practice Address - Fax:727-824-5731
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-07
Last Update Date:2014-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL140227001516Medicaid