Provider Demographics
NPI:1861780272
Name:MONAHAN, STEPHANIE LYNN (ARNP)
Entity type:Individual
Prefix:MRS
First Name:STEPHANIE
Middle Name:LYNN
Last Name:MONAHAN
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:MS
Other - First Name:STEPHANIE
Other - Middle Name:LYNN
Other - Last Name:QUERIPEL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ARNP
Mailing Address - Street 1:325 CLYDE MORRIS BLVD STE 340
Mailing Address - Street 2:
Mailing Address - City:ORMOND BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32174-3199
Mailing Address - Country:US
Mailing Address - Phone:386-615-8971
Mailing Address - Fax:
Practice Address - Street 1:325 CLYDE MORRIS BLVD STE 340
Practice Address - Street 2:
Practice Address - City:ORMOND BEACH
Practice Address - State:FL
Practice Address - Zip Code:32174-3199
Practice Address - Country:US
Practice Address - Phone:386-615-8971
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-19
Last Update Date:2013-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9323605363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health