Provider Demographics
NPI:1821823014
Name:MONTOYA, JHONNY (NP)
Entity type:Individual
Prefix:
First Name:JHONNY
Middle Name:
Last Name:MONTOYA
Suffix:
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1642 N VOLUSIA AVE
Mailing Address - Street 2:
Mailing Address - City:ORANGE CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32763-3842
Mailing Address - Country:US
Mailing Address - Phone:386-774-0188
Mailing Address - Fax:386-774-1327
Practice Address - Street 1:1642 N VOLUSIA AVE
Practice Address - Street 2:
Practice Address - City:ORANGE CITY
Practice Address - State:FL
Practice Address - Zip Code:32763-3842
Practice Address - Country:US
Practice Address - Phone:386-774-0188
Practice Address - Fax:386-774-1327
Is Sole Proprietor?:No
Enumeration Date:2024-09-05
Last Update Date:2025-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN11036425363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily