Healthcare Provider Details

I. General information

NPI: 1730684655
Provider Name (Legal Business Name): MARISSA MANANSALA ARANZASO ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/25/2018
Last Update Date: 05/10/2024
Certification Date: 05/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

558 ABBOTT ST STE A
SALINAS CA
93901-4326
US

IV. Provider business mailing address

3524 SILVER BLUFF BLVD
ORANGE PARK FL
32065-5257
US

V. Phone/Fax

Practice location:
  • Phone: 831-755-7880
  • Fax:
Mailing address:
  • Phone: 904-571-8959
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number9294713
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: