Provider Demographics
NPI:1093266470
Name:FREEMAN, MONICA (FNP-C)
Entity type:Individual
Prefix:
First Name:MONICA
Middle Name:
Last Name:FREEMAN
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1717 COUNTY ROAD 220 APT 3108
Mailing Address - Street 2:
Mailing Address - City:FLEMING ISLAND
Mailing Address - State:FL
Mailing Address - Zip Code:32003-9114
Mailing Address - Country:US
Mailing Address - Phone:660-624-4465
Mailing Address - Fax:
Practice Address - Street 1:865 BLANDING BLVD
Practice Address - Street 2:
Practice Address - City:ORANGE PARK
Practice Address - State:FL
Practice Address - Zip Code:32065-8917
Practice Address - Country:US
Practice Address - Phone:904-276-1133
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-10-20
Last Update Date:2024-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2007002622163W00000X
CA95026969363LF0000X
MO2016036906363LF0000X
FL11028996363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily