Provider Demographics
NPI:1477541936
Name:MANLEY, ALICE BERTHA (ARNP)
Entity Type:Individual
Prefix:
First Name:ALICE
Middle Name:BERTHA
Last Name:MANLEY
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:ALICE
Other - Middle Name:BERTHA
Other - Last Name:STANFIELD
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:ARNP
Mailing Address - Street 1:1290 GOLFVIEW AVE
Mailing Address - Street 2:4TH FLOOR ATTN BILLING DEPARTMENT
Mailing Address - City:BARTOW
Mailing Address - State:FL
Mailing Address - Zip Code:33830-6738
Mailing Address - Country:US
Mailing Address - Phone:863-519-7900
Mailing Address - Fax:863-519-7696
Practice Address - Street 1:1805 HOBBS RD
Practice Address - Street 2:
Practice Address - City:AUBURNDALE
Practice Address - State:FL
Practice Address - Zip Code:33823-4644
Practice Address - Country:US
Practice Address - Phone:863-965-5400
Practice Address - Fax:863-965-3739
Is Sole Proprietor?:No
Enumeration Date:2005-10-10
Last Update Date:2010-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP127374363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL034043000Medicaid
E4395ZMedicare ID - Type Unspecified
FL034043000Medicaid