Healthcare Provider Details

I. General information

NPI: 1003134792
Provider Name (Legal Business Name): MANISE SAINTIL
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/06/2010
Last Update Date: 05/06/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5977 NW BAYNARD DR
PORT SAINT LUCIE FL
34986-3604
US

IV. Provider business mailing address

5977 NW BAYNARD DR
PORT SAINT LUCIE FL
34986-3604
US

V. Phone/Fax

Practice location:
  • Phone: 772-224-1824
  • Fax:
Mailing address:
  • Phone: 772-224-1824
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code311ZA0620X
TaxonomyAdult Care Home Facility
License Number6906388
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: