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1265545297

NPI Code Detail

MEDICARE: MS. MARCI MICHELLE MANNA MD

MEDICARE: MS. MARCI MICHELLE MANNA MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2084P0800X	Psychiatry Physician	036141427	IL
2	2084P0800X	Psychiatry Physician	MD149372	FL
3	2084B0002X	Obesity Medicine (Psychiatry & Neurology) Physician	ME149372	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1265545297
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. MARCI MICHELLE MANNA MD

Provider Business Mailing Address
First Line	:	713 E MARION AVE STE 139
Second Line	:
City	:	PUNTA GORDA
State	:	FL
Zip	:	33950-3863
Country	:	US
Telephone Number	:	941-833-1750
Fax Number	:	941-766-1511

Provider Business Practice Location Address
First Line	:	713 E MARION AVE STE 139
Second Line	:
City	:	PUNTA GORDA
State	:	FL
Zip	:	33950-3863
Country	:	US
Telephone Number	:	941-833-1750
Fax Number	:	941-766-1511

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/16/2006
Last Update Date	:	07/17/2023

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Practice Location Address:

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1316210263 — CARRIE ELIZABETH INGRAM RN, MSN, APRN
Practice Location Address:

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Practice Fax: 941-766-1511

Directions to “ MS. MARCI MICHELLE MANNA MD” Practice Location

Language	Start Address	Practice Location

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