Provider Demographics
NPI:1265811855
Name:MANN, NYOKA
Entity type:Individual
Prefix:
First Name:NYOKA
Middle Name:
Last Name:MANN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5601 EDENFIELD RD
Mailing Address - Street 2:APARTMENT 608
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32277-9419
Mailing Address - Country:US
Mailing Address - Phone:904-401-0472
Mailing Address - Fax:
Practice Address - Street 1:6999 MERRILL RD STE 2
Practice Address - Street 2:#326
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32277-2690
Practice Address - Country:US
Practice Address - Phone:904-401-0472
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-05-28
Last Update Date:2015-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL103TM1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TM1800XBehavioral Health & Social Service ProvidersPsychologistIntellectual & Developmental Disabilities