MEDICARE: MERCY MANANA PA-C

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	363A00000X	Physician Assistant	PA9116427	FL

General Provider Information

NPI Number	:	1316661184
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MERCY MANANA PA-C

Provider Business Mailing Address
First Line	:	18101 NW 68TH AVE APT B104
Second Line	:
City	:	HIALEAH
State	:	FL
Zip	:	33015-3990
Country	:	US
Telephone Number	:	305-965-0688
Fax Number	:

Provider Business Practice Location Address
First Line	:	18101 NW 68TH AVE APT B104
Second Line	:
City	:	HIALEAH
State	:	FL
Zip	:	33015-3990
Country	:	US
Telephone Number	:	305-965-0688
Fax Number	:

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

Provider Enumeration Date	:	09/26/2022
Last Update Date	:	09/26/2022

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Directions to “ MERCY MANANA PA-C” Practice Location

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