Provider Demographics
NPI:1780425892
Name:REVELL, MONTE
Entity type:Individual
Prefix:
First Name:MONTE
Middle Name:
Last Name:REVELL
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:PO BOX 13834
Mailing Address - Street 2:
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32317-3834
Mailing Address - Country:US
Mailing Address - Phone:850-205-6232
Mailing Address - Fax:855-975-0615
Practice Address - Street 1:425 W 19TH ST STE D&E
Practice Address - Street 2:
Practice Address - City:PANAMA CITY
Practice Address - State:FL
Practice Address - Zip Code:32405-4659
Practice Address - Country:US
Practice Address - Phone:850-818-0220
Practice Address - Fax:850-818-0156
Is Sole Proprietor?:No
Enumeration Date:2024-06-03
Last Update Date:2025-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant