Provider Demographics
NPI:1053707448
Name:HOLBERT, MONICA CAREY (FNP-C)
Entity type:Individual
Prefix:
First Name:MONICA
Middle Name:CAREY
Last Name:HOLBERT
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:MONICA
Other - Middle Name:CAREY
Other - Last Name:PROFFITT
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:FNP-C
Mailing Address - Street 1:PO BOX 2147
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33902-2147
Mailing Address - Country:US
Mailing Address - Phone:239-343-6202
Mailing Address - Fax:239-343-4159
Practice Address - Street 1:9800 S HEALTHPARK DR STE 110
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33908-3630
Practice Address - Country:US
Practice Address - Phone:239-343-6202
Practice Address - Fax:239-343-4159
Is Sole Proprietor?:No
Enumeration Date:2015-04-13
Last Update Date:2024-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71008391A363LF0000X
SC19286363LF0000X
VA0024181748363LF0000X
FLAPRN11028676363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCNP3234Medicaid
FL120540600Medicaid