Provider Demographics
NPI:1790548568
Name:MANN, CLAUDIA MICHELLE (PA-C)
Entity Type:Individual
Prefix:
First Name:CLAUDIA
Middle Name:MICHELLE
Last Name:MANN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5181 PRAIRIE DUNES VILLAGE CIR
Mailing Address - Street 2:
Mailing Address - City:LAKE WORTH
Mailing Address - State:FL
Mailing Address - Zip Code:33463-8217
Mailing Address - Country:US
Mailing Address - Phone:561-293-1997
Mailing Address - Fax:
Practice Address - Street 1:1203 W AUGUSTA BLVD STE 1
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60642-4327
Practice Address - Country:US
Practice Address - Phone:773-248-2255
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-02-05
Last Update Date:2024-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL085010328363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant