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General NPI Number Information
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NPI Number | 1275243628
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Entity Type | Individual
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Provider Name | ABBY NICOLE MANACK MS, RD, LDN
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Gender | Female
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Dates
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Enumeration Date | 11/28/2022
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Last Update Date | 08/17/2026
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Provider Practice Location Address
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Address Line | 10485 SENEGAL DR
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City | PENSACOLA
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State | FL
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Zip | 32534-9785
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Country | US
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Telephone | 330-696-1299
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Fax |
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Provider Business Mailing Address
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Address Line | 10485 SENEGAL DR
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City | PENSACOLA
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State | FL
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Zip | 32534-9785
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Country | US
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Telephone | 330-696-1299
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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 | 133VN1501X
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Taxonomy Name | Sports Dietetics Nutrition Registered Dietitian
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License Number | 86174000
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License Number State |
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