Provider Demographics
NPI:1477197861
Name:MANERA, ELEANOR EMONG (NURSE PRACTITIONER)
Entity Type:Individual
Prefix:
First Name:ELEANOR
Middle Name:EMONG
Last Name:MANERA
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10774 125TH AVE
Mailing Address - Street 2:
Mailing Address - City:LARGO
Mailing Address - State:FL
Mailing Address - Zip Code:33778-2712
Mailing Address - Country:US
Mailing Address - Phone:727-412-4898
Mailing Address - Fax:
Practice Address - Street 1:10774 125TH AVE
Practice Address - Street 2:
Practice Address - City:LARGO
Practice Address - State:FL
Practice Address - Zip Code:33778-2712
Practice Address - Country:US
Practice Address - Phone:727-412-4898
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-30
Last Update Date:2019-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11004868363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care