Provider Demographics
NPI:1013213065
Name:MANATEE MEMORIAL
Entity Type:Organization
Organization Name:MANATEE MEMORIAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ARNP-C
Authorized Official - Prefix:MRS
Authorized Official - First Name:ERICA
Authorized Official - Middle Name:MARIE-TYNE
Authorized Official - Last Name:DISANTO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:941-232-3355
Mailing Address - Street 1:2811 38TH AVE W
Mailing Address - Street 2:
Mailing Address - City:BRADENTON
Mailing Address - State:FL
Mailing Address - Zip Code:34205-3536
Mailing Address - Country:US
Mailing Address - Phone:941-751-0559
Mailing Address - Fax:
Practice Address - Street 1:206 2ND ST E
Practice Address - Street 2:
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34208-1042
Practice Address - Country:US
Practice Address - Phone:941-745-7419
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-02-08
Last Update Date:2011-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9227132363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty