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General NPI Number Information
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NPI Number | 1669896528
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Entity Type | Individual
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Provider Name | ALACIA MAHNKEN PA-C
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Gender | Female
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Dates
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Enumeration Date | 02/13/2014
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Last Update Date | 02/13/2014
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Provider Practice Location Address
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Address Line | 14000 FIVAY RD
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City | HUDSON
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State | FL
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Zip | 34667-7103
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Country | US
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Telephone | 727-507-3646
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Fax |
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Provider Business Mailing Address
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Address Line | 7757 62ND WAY N APT B
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City | PINELLAS PARK
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State | FL
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Zip | 33781-3217
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Country | US
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Telephone | 727-466-7227
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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 | 9107766
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License Number State | FL
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