MEDICARE: KAMIAH WYNN MANN FNP-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	363L00000X	Nurse Practitioner	RN9369655	FL

General Provider Information

NPI Number	:	1477433506
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KAMIAH WYNN MANN FNP-C

Provider Business Mailing Address
First Line	:	15067 LELAND CIR
Second Line	:
City	:	TALLAHASSEE
State	:	FL
Zip	:	32309-8670
Country	:	US
Telephone Number	:	850-363-2809
Fax Number	:	850-363-2809

Provider Business Practice Location Address
First Line	:	2639 N MONROE ST STE 100
Second Line	:
City	:	TALLAHASSEE
State	:	FL
Zip	:	32303-4073
Country	:	US
Telephone Number	:	850-363-2809
Fax Number	:	850-363-2809

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

Provider Enumeration Date	:	09/08/2025
Last Update Date	:	12/09/2025

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