Healthcare Provider Details

I. General information

NPI: 1609401082
Provider Name (Legal Business Name): OLIVIA MANIOTIS PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/06/2020
Last Update Date: 01/11/2024
Certification Date: 01/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3200 S UNIVERSITY DR
DAVIE FL
33328-2018
US

IV. Provider business mailing address

2532 CONROY DR
WEST PALM BEACH FL
33403-1402
US

V. Phone/Fax

Practice location:
  • Phone: 954-262-1250
  • Fax:
Mailing address:
  • Phone: 904-343-5173
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA9114891
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: