Provider Demographics
NPI:1871648964
Name:MANZI, MONICA ANN (PA-C)
Entity Type:Individual
Prefix:
First Name:MONICA
Middle Name:ANN
Last Name:MANZI
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 1:13808 PROFESSIONAL CENTER DR
Mailing Address - Street 2:
Mailing Address - City:HUNTERSVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28078-7948
Mailing Address - Country:US
Mailing Address - Phone:704-717-5549
Mailing Address - Fax:704-602-6563
Practice Address - Street 1:15830 BALLANTYNE MEDICAL PL STE 175
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28277-0763
Practice Address - Country:US
Practice Address - Phone:704-377-4009
Practice Address - Fax:704-543-3198
Is Sole Proprietor?:No
Enumeration Date:2007-01-25
Last Update Date:2018-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC103427363A00000X, 363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
2756976CMedicare PIN
P69181Medicare UPIN
2756976AMedicare ID - Type Unspecified