Monique Manderson, FNP-C, PMHNP-BC

Primary specialty

Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X

License

11014186 Issued in FL

Practice address

122 E Main St Ste 124
Lakeland, FL 33801-4655

Phone

(708) 205-3517

NPI assigned

Mar 10, 2015

Last updated

Feb 18, 2026By the provider in NPPES

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 5

Addresses

Medicare fee-for-service enrollment

Enrolled in IL, MO, WA3 enrollments

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 3

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Comprehensive Healthcare

  • Community/Behavioral Health Agency
  • Yakima, WA
  • NPI 1073527453
  Medicare reassignment NPD
• Illinois Department of Human Services

  • Intellectual Disabilities Intermediate Care Facility
  • Centralia, IL
  • NPI 1003960394
  Medicare reassignment NPD
• Palouse River Counseling Center

  dba Palouse River Counseling

  • Community/Behavioral Health Agency
  • Pullman, WA
  • NPI 1063486272
  Medicare reassignment NPD
• St. Mary's Hospital, Centralia, Illinois

  dba SSM Health St. Mary's Hospital - Centralia

  • Emergency Medicine Physician
  • Centralia, IL
  • NPI 1770687196
  Medicare reassignment NPD
• Clinical Research Associates, PC

  dba Long Term Psychiatric Management

  • Psychiatry Physician
  • Saint Louis, MO
  • NPI 1063632826
  Medicare reassignment
• Stages Health & Wellness, LLC

  • Family Nurse Practitioner
  • Lakeland, FL
  • NPI 1417464918
  Authorized official Same address or phone
• Comprehensive Healthcare

  • Methadone Clinic
  • Yakima, WA
  • NPI 1588871693
  NPD
• Illinois Department of Human Services

  • Psychiatric Hospital
  • Chester, IL
  • NPI 1306834726
  NPD
• Illinois Department of Human Services

  dba John J Madden Mental Health

  • Psychiatric Hospital
  • Hines, IL
  • NPI 1902903487
  NPD
• St. Mary's Hospital, Centralia, Illinois

  dba SSM Health St. Mary's Hospital - Centralia

  • Comprehensive Outpatient Rehabilitation Facility (CORF)
  • Centralia, IL
  • NPI 1710105192
  NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1425945600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1771372800000",
    "number": "1619360070",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "122 E MAIN ST STE 124",
            "city": "LAKELAND",
            "state": "FL",
            "postal_code": "338014655",
            "telephone_number": "708-205-3517"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "122 E MAIN ST STE 124",
            "city": "LAKELAND",
            "state": "FL",
            "postal_code": "338014655",
            "telephone_number": "708-205-3517"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MANDERSON",
        "first_name": "MONIQUE",
        "name_prefix": "Ms.",
        "credential": "FNP-C, PMHNP-BC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2015-03-10",
        "last_updated": "2026-02-18",
        "certification_date": "2026-02-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "IL",
            "license": "209012605",
            "primary": false
        },
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "AZ",
            "license": "AP11235",
            "primary": false
        },
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "IL",
            "license": "209012605",
            "primary": false
        },
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "WA",
            "license": "AP61438293",
            "primary": false
        },
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "FL",
            "license": "11014186",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Hayley Renee Maloy, LCSW
• Demetra Malveaux, OTA
• William F Malzone, M.D.
• Avinash Mamgain
• Bernard Mamphey, OD
• Maneesha Chigurupati DDS, PLLC
• Catherine Concepcion Mangalili, APRN
• Jessica Jane Manges, ARNP
• Marizza Mangune-Kalaw
• Carley Adele Maniscalco, CF-SLP

• Psychiatric/Mental Health Nurse Practitioner in Lakeland, FL
• Providers in Lakeland, FL by specialty
• Psychiatric/Mental Health Nurse Practitioner in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 18, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.