Healthcare Provider Details

I. General information

NPI: 1356847388
Provider Name (Legal Business Name): STEFAN SAMUEL MANN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/30/2018
Last Update Date: 11/25/2025
Certification Date: 11/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

817 NW 56TH TER STE B
GAINESVILLE FL
32605-6401
US

IV. Provider business mailing address

817 NW 56TH TER STE B
GAINESVILLE FL
32605-6401
US

V. Phone/Fax

Practice location:
  • Phone: 352-234-3050
  • Fax: 352-553-4800
Mailing address:
  • Phone: 352-234-3050
  • Fax: 352-553-4800

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberME145111
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License NumberME145111
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License NumberME145111
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: