Provider Demographics
NPI:1831801489
Name:MONTAN, PETER D. (FNP-BC, APRN)
Entity type:Individual
Prefix:
First Name:PETER D.
Middle Name:
Last Name:MONTAN
Suffix:
Gender:M
Credentials:FNP-BC, APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:366 HIDDEN PALM CIR APT 304
Mailing Address - Street 2:
Mailing Address - City:KISSIMMEE
Mailing Address - State:FL
Mailing Address - Zip Code:34747-2027
Mailing Address - Country:US
Mailing Address - Phone:917-728-9528
Mailing Address - Fax:
Practice Address - Street 1:366 HIDDEN PALM CIR APT 304
Practice Address - Street 2:
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34747-2027
Practice Address - Country:US
Practice Address - Phone:917-728-9528
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-12-14
Last Update Date:2022-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11023504363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily