Provider Demographics
NPI:1942217476
Name:MANN, NANCY A (CRNA)
Entity Type:Individual
Prefix:
First Name:NANCY
Middle Name:A
Last Name:MANN
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:210 UTOPIA CIR
Mailing Address - Street 2:
Mailing Address - City:MERRITT ISLAND
Mailing Address - State:FL
Mailing Address - Zip Code:32952-7101
Mailing Address - Country:US
Mailing Address - Phone:321-459-0717
Mailing Address - Fax:
Practice Address - Street 1:1340 MEDICAL PARK DR
Practice Address - Street 2:SUITE 101
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32901-3246
Practice Address - Country:US
Practice Address - Phone:321-729-9493
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP 159422367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
G1415Medicare ID - Type Unspecified