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General NPI Number Information
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NPI Number | 1831503911
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Entity Type | Organization
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Legal Business Name | ARTERY AND VEIN SPECIALISTS OF THE EMERALD COAST, INC.
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Dates
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Enumeration Date | 06/17/2014
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Last Update Date | 02/10/2026
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Provider Practice Location Address
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Address Line | 4615 NW 53RD AVE
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City | GAINESVILLE
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State | FL
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Zip | 32653-4809
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Country | US
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Telephone | 850-398-2548
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Fax |
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Provider Business Mailing Address
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Address Line | 4615 NW 53RD AVE
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City | GAINESVILLE
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State | FL
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Zip | 32653-4809
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Country | US
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Telephone | 850-398-2548
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Fax | 850-398-2548
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Authorized Official
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Title or Position | MEDICAL DOCTOR
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Name | GINGER LYNNE MANOS
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Credential | MD
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Telephone | 850-398-2548
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2086S0129X
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Taxonomy Name | Vascular Surgery Physician
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License Number | MD32127
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License Number State | AL
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Taxonomy #2
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Taxonomy Code | 2086S0129X
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Taxonomy Name | Vascular Surgery Physician
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License Number | 75309
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License Number State | GA
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Taxonomy #3
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Taxonomy Code | 2086S0129X
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Taxonomy Name | Vascular Surgery Physician
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License Number | MD32487
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License Number State | SC
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Taxonomy #4
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Taxonomy Code | 2086S0129X
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Taxonomy Name | Vascular Surgery Physician
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License Number | ME112123
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License Number State | FL
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