Provider Demographics
NPI:1154938413
Name:ALEXIS, MONIQUE CHERYL
Entity type:Individual
Prefix:MRS
First Name:MONIQUE
Middle Name:CHERYL
Last Name:ALEXIS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:150 NW 70TH AVE
Mailing Address - Street 2:STE 7
Mailing Address - City:PLANTATION
Mailing Address - State:FL
Mailing Address - Zip Code:33317-2911
Mailing Address - Country:US
Mailing Address - Phone:754-244-8434
Mailing Address - Fax:
Practice Address - Street 1:150 NW 70TH AVE
Practice Address - Street 2:STE 7
Practice Address - City:PLANTATION
Practice Address - State:FL
Practice Address - Zip Code:33317-2911
Practice Address - Country:US
Practice Address - Phone:954-247-7630
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-30
Last Update Date:2021-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN11007045363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health