Provider Demographics
NPI:1205346715
Name:PEAN, MONETTE (ARNP)
Entity type:Individual
Prefix:MS
First Name:MONETTE
Middle Name:
Last Name:PEAN
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 1:3990 NW 51ST AVE
Mailing Address - Street 2:
Mailing Address - City:LAUDERDALE LAKES
Mailing Address - State:FL
Mailing Address - Zip Code:33319-6534
Mailing Address - Country:US
Mailing Address - Phone:954-682-8112
Mailing Address - Fax:
Practice Address - Street 1:818 S DIXIE HWY
Practice Address - Street 2:
Practice Address - City:LAKE WORTH
Practice Address - State:FL
Practice Address - Zip Code:33460-5042
Practice Address - Country:US
Practice Address - Phone:561-296-4400
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-10-10
Last Update Date:2022-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9183719363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner