MEDICARE: MANOUCHEKA CADET 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
1	164W00000X	Licensed Practical Nurse	314634	NY
2	363LF0000X	Family Nurse Practitioner	APRN11036324	FL

General Provider Information

NPI Number	:	1881021467
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MANOUCHEKA CADET APRN

Provider Business Mailing Address
First Line	:	13436 BOUVARDIA LN
Second Line	:
City	:	PORT CHARLOTTE
State	:	FL
Zip	:	33981-3944
Country	:	US
Telephone Number	:	845-803-5162
Fax Number	:

Provider Business Practice Location Address
First Line	:	2828 S MCCALL RD STE 21
Second Line	:
City	:	ENGLEWOOD
State	:	FL
Zip	:	34224-9517
Country	:	US
Telephone Number	:	941-290-5111
Fax Number	:

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

Provider Enumeration Date	:	09/27/2013
Last Update Date	:	07/02/2025

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Directions to “ MANOUCHEKA CADET APRN” Practice Location

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