Individual
MS. MONIQUE MANDERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP-C, PMHNP-BC
Contact information
Practice address
122 E MAIN ST STE 124, LAKELAND, FL 33801-4655
(708) 205-3517
Mailing address
122 E MAIN ST STE 124, LAKELAND, FL 33801-4655
(708) 205-3517
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
4704422305
MI
363LF0000X
Family Nurse Practitioner
209012605
IL
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
11014186
FL
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
209012605
IL
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
AP11235
AZ
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
AP61438293
WA
Other
Enumeration date
03/10/2015
Last updated
02/18/2026
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