Provider Demographics
NPI:1568862894
Name:EMANUEL, FRATINA (MED)
Entity Type:Individual
Prefix:
First Name:FRATINA
Middle Name:
Last Name:EMANUEL
Suffix:
Gender:F
Credentials:MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3750 SILVER BLUFF BLVD APT 2908
Mailing Address - Street 2:
Mailing Address - City:ORANGE PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32065-4270
Mailing Address - Country:US
Mailing Address - Phone:256-797-1367
Mailing Address - Fax:
Practice Address - Street 1:3750 SILVER BLUFF BLVD APT 2908
Practice Address - Street 2:
Practice Address - City:ORANGE PARK
Practice Address - State:FL
Practice Address - Zip Code:32065-4270
Practice Address - Country:US
Practice Address - Phone:256-797-1367
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-22
Last Update Date:2014-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist