Provider Demographics
NPI:1477138329
Name:MANASHEROV, ANNA (NP-C)
Entity Type:Individual
Prefix:
First Name:ANNA
Middle Name:
Last Name:MANASHEROV
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:ANNA
Other - Middle Name:
Other - Last Name:BUBIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2751 S DIXIE HWY STE 401
Mailing Address - Street 2:
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33405-1233
Mailing Address - Country:US
Mailing Address - Phone:561-253-3980
Mailing Address - Fax:561-253-3985
Practice Address - Street 1:11382 PROSPERITY FARMS RD STE 228
Practice Address - Street 2:
Practice Address - City:PALM BEACH GARDENS
Practice Address - State:FL
Practice Address - Zip Code:33410-3463
Practice Address - Country:US
Practice Address - Phone:561-253-3980
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-12
Last Update Date:2021-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN11011824363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner