Provider Demographics
NPI:1679352488
Name:MANN, COLE K
Entity Type:Individual
Prefix:
First Name:COLE
Middle Name:K
Last Name:MANN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:464099 STATE ROAD 200 STE 2
Mailing Address - Street 2:
Mailing Address - City:YULEE
Mailing Address - State:FL
Mailing Address - Zip Code:32097-6460
Mailing Address - Country:US
Mailing Address - Phone:904-875-4461
Mailing Address - Fax:
Practice Address - Street 1:464099 STATE ROAD 200 STE 2
Practice Address - Street 2:
Practice Address - City:YULEE
Practice Address - State:FL
Practice Address - Zip Code:32097-6460
Practice Address - Country:US
Practice Address - Phone:904-875-4461
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-22
Last Update Date:2023-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician