Provider Demographics
NPI:1295562544
Name:FALTAS, MONICA
Entity type:Individual
Prefix:
First Name:MONICA
Middle Name:
Last Name:FALTAS
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 1:2443 HIBISCUS BAY LN
Mailing Address - Street 2:
Mailing Address - City:BRANDON
Mailing Address - State:FL
Mailing Address - Zip Code:33511-1201
Mailing Address - Country:US
Mailing Address - Phone:615-719-4263
Mailing Address - Fax:
Practice Address - Street 1:4625 E BAY DR STE 222
Practice Address - Street 2:
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33764-6867
Practice Address - Country:US
Practice Address - Phone:727-288-9988
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-18
Last Update Date:2025-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9119862363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical