Provider Demographics
NPI:1053808360
Name:DACIUS, MONET JENIECE (APRN)
Entity type:Individual
Prefix:
First Name:MONET
Middle Name:JENIECE
Last Name:DACIUS
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:MONET
Other - Middle Name:JENIECE
Other - Last Name:SCOTT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APRN
Mailing Address - Street 1:10129 BEDFORD LAKES CT
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32222-4119
Mailing Address - Country:US
Mailing Address - Phone:904-742-9416
Mailing Address - Fax:
Practice Address - Street 1:4655 SALISBURY RD STE 220
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32256-0959
Practice Address - Country:US
Practice Address - Phone:904-570-9404
Practice Address - Fax:904-900-2224
Is Sole Proprietor?:No
Enumeration Date:2018-04-23
Last Update Date:2024-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9338936163W00000X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLAPRN9338936OtherPROFESSIONAL LICENSE FL-DOH
FLMS5215416OtherDEA
FL105348300Medicaid