Provider Demographics
NPI:1992538599
Name:MATHEWS, MONIKA ROSALIE (RN)
Entity type:Individual
Prefix:
First Name:MONIKA
Middle Name:ROSALIE
Last Name:MATHEWS
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:MONIKA
Other - Middle Name:ROSALIE
Other - Last Name:EDENS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:110 DESOTO PKWY APT 7
Mailing Address - Street 2:
Mailing Address - City:SATELLITE BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32937-3361
Mailing Address - Country:US
Mailing Address - Phone:321-749-3076
Mailing Address - Fax:
Practice Address - Street 1:1381 S PATRICK DR
Practice Address - Street 2:
Practice Address - City:PATRICK AIR FORCE BASE
Practice Address - State:FL
Practice Address - Zip Code:32925-3606
Practice Address - Country:US
Practice Address - Phone:321-494-8241
Practice Address - Fax:321-494-8334
Is Sole Proprietor?:No
Enumeration Date:2024-08-21
Last Update Date:2024-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRN9434907163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse