Provider Demographics
NPI:1770841926
Name:MANSO, VLADIMIR (APRN)
Entity Type:Individual
Prefix:
First Name:VLADIMIR
Middle Name:
Last Name:MANSO
Suffix:
Gender:M
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2231 MCGREGOR BLVD
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33901-3311
Mailing Address - Country:US
Mailing Address - Phone:239-210-9980
Mailing Address - Fax:
Practice Address - Street 1:2231 MCGREGOR BLVD
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33901-3311
Practice Address - Country:US
Practice Address - Phone:239-210-9980
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-25
Last Update Date:2023-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN11005944363L00000X
104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No104100000XBehavioral Health & Social Service ProvidersSocial Worker