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General NPI Number Information
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NPI Number | 1194542332
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Entity Type | Individual
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Provider Name | ANYA MANCINELLI PA-C
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Gender | Female
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Dates
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Enumeration Date | 09/19/2024
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Last Update Date | 10/28/2024
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Provider Practice Location Address
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Address Line | 1001 W CLEVELAND ST
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City | TAMPA
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State | FL
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Zip | 33606-1913
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Country | US
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Telephone | 813-425-5005
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Fax |
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Provider Business Mailing Address
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Address Line | 5145 S DALE MABRY HWY UNIT 14108
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City | TAMPA
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State | FL
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Zip | 33611-3594
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | PA9119221
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License Number State | FL
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