Provider Demographics
NPI:1225623473
Name:ROBERTS, MANUELA ELISE
Entity Type:Individual
Prefix:
First Name:MANUELA
Middle Name:ELISE
Last Name:ROBERTS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1661 W OAK RIDGE RD APT D
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32809-3950
Mailing Address - Country:US
Mailing Address - Phone:407-536-1280
Mailing Address - Fax:
Practice Address - Street 1:1661 W OAK RIDGE RD APT D
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32809-3950
Practice Address - Country:US
Practice Address - Phone:407-536-1280
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-09
Last Update Date:2021-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLR163-540-75-882-0372600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes372600000XNursing Service Related ProvidersAdult Companion
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLRN9188809OtherSENIOR COMPANION CARE