Monica M Immordino, NP

Primary specialty

Gerontology Nurse PractitionerTaxonomy code 363LG0600X

License

APRN9426913 Issued in FL

Practice address

20 Blanding Blvd
Orange Park, FL 32073-2235

Phone

(904) 773-8977

Fax

(904) 773-8974

NPI assigned

Nov 17, 2006

Sex

Female

Sole proprietor

No

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

Specialties & licenses 3

Addresses

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in FL

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 1

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 and National Provider Directory roles.

• Conviva Medical Center Management LLC

  • Internal Medicine Physician
  • Miami, FL
  • NPI 1649324278
  Medicare reassignment NPD
• HCR Manorcare Medical Services of Florida LLC

  • Nurse Practitioner
  • Toledo, OH
  • NPI 1386750420

  FL

  Medicare reassignment

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

{
    "created_epoch": "1163721600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1646179200000",
    "number": "1831263243",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6101 BLUE LAGOON DR STE 400",
            "city": "MIAMI",
            "state": "FL",
            "postal_code": "331262051",
            "telephone_number": "305-500-2000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "20 BLANDING BLVD",
            "city": "ORANGE PARK",
            "state": "FL",
            "postal_code": "320732235",
            "telephone_number": "904-773-8977",
            "fax_number": "904-773-8974"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1525 N Rolling Road",
            "address_purpose": "LOCATION",
            "city": "Catonsville",
            "state": "MD",
            "postal_code": "21228",
            "country_code": "US",
            "telephone_number": "410-402-1200",
            "fax_number": "410-719-6918",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "IMMORDINO",
        "first_name": "MONICA",
        "middle_name": "M",
        "credential": "NP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-11-17",
        "last_updated": "2022-03-02",
        "certification_date": "2022-03-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "MD",
            "license": "R114730",
            "primary": false
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "FL",
            "license": "APRN9426913",
            "primary": false
        },
        {
            "code": "363LG0600X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Gerontology",
            "state": "FL",
            "license": "APRN9426913",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "monica.immordino@conviva.eclinicaldirectplus.com",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "address_1": "20 Blanding Blvd",
            "city": "Orange Park",
            "state": "FL",
            "country_code": "US",
            "postal_code": "320732235",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Hyatt Haven Mental Health Clinic
• Audrah Hyatt
• Joan Shannon Hyland, DO
• David Scribner Hyler II, M.D.
• Misty Hysmith, PTA
• In Search of a New Beginning, Inc
• Independence Living Solutions Inc
• Kathryn Kelly Ingram-Mitchell, MPT
• Danielle Ingram
• Erica Inman

• Gerontology Nurse Practitioner in Orange Park, FL
• Providers in Orange Park, FL by specialty
• Gerontology Nurse Practitioner in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 2, 2022; 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.