Provider Demographics
NPI:1174143366
Name:PIERRE, MANOUCHKA CLITUS (ARNP)
Entity type:Individual
Prefix:
First Name:MANOUCHKA
Middle Name:CLITUS
Last Name:PIERRE
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3463 FALMOUTH CT
Mailing Address - Street 2:
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32317-9016
Mailing Address - Country:US
Mailing Address - Phone:561-543-2134
Mailing Address - Fax:
Practice Address - Street 1:3463 FALMOUTH CT
Practice Address - Street 2:
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32317-9016
Practice Address - Country:US
Practice Address - Phone:561-543-2134
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-04-17
Last Update Date:2021-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11006609363L00000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner