Provider Demographics
NPI:1225617236
Name:MANDERNACH, PAIGE (APRN)
Entity Type:Individual
Prefix:MRS
First Name:PAIGE
Middle Name:
Last Name:MANDERNACH
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:PAIGE
Other - Middle Name:
Other - Last Name:FITZSIMMONS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3011 EGLINGTON DR
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32806-3366
Mailing Address - Country:US
Mailing Address - Phone:954-806-8909
Mailing Address - Fax:
Practice Address - Street 1:3011 EGLINGTON DR
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32806-3366
Practice Address - Country:US
Practice Address - Phone:954-806-8909
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-06
Last Update Date:2023-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11026564367500000X
FL9462847163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No163W00000XNursing Service ProvidersRegistered Nurse