Provider Demographics
NPI:1528628385
Name:GRIMALDO, MONICA ENPERATRIS (FNP-C)
Entity type:Individual
Prefix:MRS
First Name:MONICA
Middle Name:ENPERATRIS
Last Name:GRIMALDO
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 1:1352 YORKSHIRE LN
Mailing Address - Street 2:
Mailing Address - City:WOODSTOCK
Mailing Address - State:GA
Mailing Address - Zip Code:30188-6371
Mailing Address - Country:US
Mailing Address - Phone:770-624-6206
Mailing Address - Fax:
Practice Address - Street 1:25 W LYON ST
Practice Address - Street 2:
Practice Address - City:TALLAPOOSA
Practice Address - State:GA
Practice Address - Zip Code:30176-1288
Practice Address - Country:US
Practice Address - Phone:770-812-2800
Practice Address - Fax:770-824-2825
Is Sole Proprietor?:No
Enumeration Date:2019-06-14
Last Update Date:2019-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN226645207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine