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NPI Code Detail

MEDICARE: DERONDA L. MANISCALCO APRN

MEDICARE: DERONDA L. MANISCALCO APRN
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
1363LF0000XFamily Nurse PractitionerARNP9187672FL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2Y004YOTHERFLBCBS

General Provider Information

NPI Number : 1740286061
Entity Type Code : Individual
Provider Name (Legal Business Name) : DERONDA L. MANISCALCO APRN
Provider Business Mailing Address
First Line : PO BOX 2699
Second Line : ATTN: SHMG/HPE
City : PENSACOLA
State : FL
Zip : 32513-2699
Country : US
Telephone Number : 850-478-2333
Fax Number : 850-478-1809
Provider Business Practice Location Address
First Line : 400 MILESTONE BLVD
Second Line :
City : CANTONMENT
State : FL
Zip : 32533-6579
Country : US
Telephone Number : 850-478-2333
Fax Number : 850-478-1809
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/22/2005
Last Update Date : 12/16/2016

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