MEDICARE: DR. PAMELA MANNING DNP, AGNP-BC

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	363LG0600X	Gerontology Nurse Practitioner	NP9292195	FL
2	363LA2200X	Adult Health Nurse Practitioner	NP9292195	FL
3	363LP2300X	Primary Care Nurse Practitioner	9292195	FL

General Provider Information

NPI Number	:	1477065316
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. PAMELA MANNING DNP, AGNP-BC

Provider Business Mailing Address
First Line	:	15084 WILDWOOD CIR
Second Line	:
City	:	WESTLAKE
State	:	FL
Zip	:	33470-5435
Country	:	US
Telephone Number	:	772-333-7070
Fax Number	:	772-303-3476

Provider Business Practice Location Address
First Line	:	1515 N UNIVERSITY DR STE 120
Second Line	:
City	:	CORAL SPRINGS
State	:	FL
Zip	:	33071-6084
Country	:	US
Telephone Number	:	954-999-4881
Fax Number	:	772-303-3476

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

Provider Enumeration Date	:	11/01/2017
Last Update Date	:	12/26/2025

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