Provider Demographics
NPI:1689485831
Name:MONTERO, EMILIO ISAAC
Entity type:Individual
Prefix:
First Name:EMILIO
Middle Name:ISAAC
Last Name:MONTERO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 44008
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32231-4008
Mailing Address - Country:US
Mailing Address - Phone:904-244-4195
Mailing Address - Fax:904-244-4908
Practice Address - Street 1:655 WEST 8TH STREET CLINICAL CENTER - 2ND FLOOR
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32209-6511
Practice Address - Country:US
Practice Address - Phone:904-244-4195
Practice Address - Fax:904-244-4908
Is Sole Proprietor?:No
Enumeration Date:2025-01-16
Last Update Date:2025-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRN9350269163W00000X
FLAPRN11037370367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No163W00000XNursing Service ProvidersRegistered Nurse