Provider Demographics
NPI:1831171289
Name:MANNING, JAMES (PA-C)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:
Last Name:MANNING
Suffix:
Gender:M
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 1:10131 W FOREST HILL BLVD
Mailing Address - Street 2:STE 230
Mailing Address - City:WELLINGTON
Mailing Address - State:FL
Mailing Address - Zip Code:33414-6156
Mailing Address - Country:US
Mailing Address - Phone:561-798-6600
Mailing Address - Fax:561-615-1958
Practice Address - Street 1:6056 BOYNTON BEACH BLVD. SUITE 215
Practice Address - Street 2:
Practice Address - City:BOYNTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:33437
Practice Address - Country:US
Practice Address - Phone:561-798-6600
Practice Address - Fax:561-615-1958
Is Sole Proprietor?:No
Enumeration Date:2005-11-18
Last Update Date:2012-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9101327363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL290885900Medicaid
FL290885900Medicaid
FLE4573ZMedicare ID - Type Unspecified