Provider Demographics
NPI:1013476795
Name:MONROE, TINA (LMT)
Entity type:Individual
Prefix:
First Name:TINA
Middle Name:
Last Name:MONROE
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9165 SE 47TH COURT RD
Mailing Address - Street 2:
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34480-5288
Mailing Address - Country:US
Mailing Address - Phone:352-427-6787
Mailing Address - Fax:
Practice Address - Street 1:3305 SW 34TH CIR STE 203
Practice Address - Street 2:
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34474-6606
Practice Address - Country:US
Practice Address - Phone:352-351-5019
Practice Address - Fax:352-224-1975
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-13
Last Update Date:2019-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA41050225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist