Individual
DR. MONICA MORTENSEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
D.O.
Contact information
Practice address
807 CHILDRENS WAY, NEMOURS CHILDRENS CLINIC, JACKSONVILLE, JACKSONVILLE, FL 32207-8426
(904) 697-3600
(904) 697-3792
Mailing address
PO BOX 191, PROVIDER ENROLLMENT DEPARTMENT, ROCKLAND, DE 19732-0191
(302) 651-6212
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
OS10132
FL
2080P0205X
Pediatric Endocrinology Physician
036-111969
IL
2080P0205X
Pediatric Endocrinology Physician
Primary
OS10132
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
10140
BCBS
FL
05
—
280412300
—
FL
05
—
362169147
—
IL
01
—
OS10132
LICENSE
FL
Enumeration date
06/14/2006
Last updated
12/10/2015
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