Healthcare Provider Details

I. General information

NPI: 1629507074
Provider Name (Legal Business Name): JANELLE MANNING
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/08/2017
Last Update Date: 06/08/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5030 ROSAMOND DRIVE APT 2712
ORLANDO FL
32808
US

IV. Provider business mailing address

5030 ROSAMOND DR APT 2712
ORLANDO FL
32808-0940
US

V. Phone/Fax

Practice location:
  • Phone: 813-898-6081
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code376K00000X
TaxonomyNurse's Aide
License Number212549
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: