Provider Demographics
NPI:1831412774
Name:MCMANUS, ANN MARIE (PA)
Entity type:Individual
Prefix:MS
First Name:ANN
Middle Name:MARIE
Last Name:MCMANUS
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:6735 CROSSWINDS DR N
Mailing Address - Street 2:
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33710-5471
Mailing Address - Country:US
Mailing Address - Phone:727-548-8500
Mailing Address - Fax:727-501-7328
Practice Address - Street 1:6735 CROSSWINDS DR N
Practice Address - Street 2:
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33710-5471
Practice Address - Country:US
Practice Address - Phone:727-548-8500
Practice Address - Fax:727-501-7328
Is Sole Proprietor?:No
Enumeration Date:2010-03-07
Last Update Date:2021-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9105351363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL5230941OtherAETNA
FL100327600Medicaid
FL3400245OtherUNITED
FLY04PQOtherFLORIDA BLUE