Provider Demographics
NPI:1316163777
Name:PEDERSEN, MONICA C (ARNP)
Entity type:Individual
Prefix:
First Name:MONICA
Middle Name:C
Last Name:PEDERSEN
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1033 DR. MARTIN LUTHER KING JR. STREET NORTH
Mailing Address - Street 2:SUITE 108
Mailing Address - City:ST. PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33701-1547
Mailing Address - Country:US
Mailing Address - Phone:727-456-3288
Mailing Address - Fax:727-456-3289
Practice Address - Street 1:1401 W ESPLANADE AVE STE 108A
Practice Address - Street 2:
Practice Address - City:KENNER
Practice Address - State:LA
Practice Address - Zip Code:70065-2800
Practice Address - Country:US
Practice Address - Phone:504-575-3712
Practice Address - Fax:504-575-3712
Is Sole Proprietor?:No
Enumeration Date:2007-04-17
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP3190362363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL308273300Medicaid