Provider Demographics
NPI:1841893963
Name:NOELUS, MANUSHKA (MSN, APRN, FNP - C)
Entity type:Individual
Prefix:
First Name:MANUSHKA
Middle Name:
Last Name:NOELUS
Suffix:
Gender:F
Credentials:MSN, APRN, FNP - C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7575 OSCEOLA POLK LINE RD
Mailing Address - Street 2:
Mailing Address - City:DAVENPORT
Mailing Address - State:FL
Mailing Address - Zip Code:33896-9112
Mailing Address - Country:US
Mailing Address - Phone:561-598-3550
Mailing Address - Fax:
Practice Address - Street 1:7575 OSCEOLA POLK LINE RD
Practice Address - Street 2:
Practice Address - City:DAVENPORT
Practice Address - State:FL
Practice Address - Zip Code:33896-9112
Practice Address - Country:US
Practice Address - Phone:321-677-0531
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-19
Last Update Date:2024-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11010115363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily