Healthcare Provider Details

I. General information

NPI: 1881021467
Provider Name (Legal Business Name): MANOUCHEKA CADET APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/27/2013
Last Update Date: 07/02/2025
Certification Date: 07/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2828 S MCCALL RD STE 21
ENGLEWOOD FL
34224-9517
US

IV. Provider business mailing address

13436 BOUVARDIA LN
PORT CHARLOTTE FL
33981-3944
US

V. Phone/Fax

Practice location:
  • Phone: 941-290-5111
  • Fax:
Mailing address:
  • Phone: 845-803-5162
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN11036324
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License Number314634
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: