Basic Information
| Provider Information | |||||||||
| NPI: | 1487014478 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | TRAYLOR | ||||||||
| FirstName: | MONICA | ||||||||
| MiddleName: | RAE | ||||||||
| NamePrefix: | MISS | ||||||||
| NameSuffix: | |||||||||
| Credential: | PA-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6041 SW 54TH ST STE 200 | ||||||||
| Address2: | |||||||||
| City: | OCALA | ||||||||
| State: | FL | ||||||||
| PostalCode: | 344745521 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3528578417 | ||||||||
| FaxNumber: | 3528772083 | ||||||||
| Practice Location | |||||||||
| Address1: | 2910 BROWNWOOD BLVD | ||||||||
| Address2: | |||||||||
| City: | THE VILLAGES | ||||||||
| State: | FL | ||||||||
| PostalCode: | 321632032 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3526741790 | ||||||||
| FaxNumber: | 3526748990 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/03/2016 | ||||||||
| LastUpdateDate: | 05/03/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 05/03/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363A00000X | PA9109388 | FL | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant |
ID Information
| ID | Type | State | Issuer | Description | 106912100 | 05 | FL | MEDICAID | 0D4ZE | 01 | FL | FLORIDA BLUE | OTHER | 5297418 | 01 | FL | CIGNA | OTHER |