Basic Information
| Provider Information | |||||||||
| NPI: | 1124692686 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MONROE | ||||||||
| FirstName: | MEGHAN | ||||||||
| MiddleName: | KRYSTINE | ||||||||
| NamePrefix: | MS. | ||||||||
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| Credential: | MSPAP, PA-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6705 S RED RD STE 518 | ||||||||
| Address2: | |||||||||
| City: | SOUTH MIAMI | ||||||||
| State: | FL | ||||||||
| PostalCode: | 331433649 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3054031181 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 6705 SW 57TH AVE | ||||||||
| Address2: | |||||||||
| City: | SOUTH MIAMI | ||||||||
| State: | FL | ||||||||
| PostalCode: | 331433622 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3054031181 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 05/18/2021 | ||||||||
| LastUpdateDate: | 08/05/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 08/05/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363A00000X | PA9114241 | FL | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant |
No ID Information.