Provider Demographics
NPI:1124584297
Name:MANNEY, MELANIE (APRN)
Entity Type:Individual
Prefix:
First Name:MELANIE
Middle Name:
Last Name:MANNEY
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:MELANIE
Other - Middle Name:
Other - Last Name:WILLIAMSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APRN
Mailing Address - Street 1:2 ZUNI CIR
Mailing Address - Street 2:
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32507-8725
Mailing Address - Country:US
Mailing Address - Phone:850-621-3109
Mailing Address - Fax:
Practice Address - Street 1:2 ZUNI CIR
Practice Address - Street 2:
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32507-8725
Practice Address - Country:US
Practice Address - Phone:850-621-3109
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-02-14
Last Update Date:2022-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN11001286363L00000X, 363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1062660Medicaid