Provider Demographics
NPI:1952914244
Name:MANIOUDAKIS, ANNA (APRN, FNP-C)
Entity type:Individual
Prefix:
First Name:ANNA
Middle Name:
Last Name:MANIOUDAKIS
Suffix:
Gender:F
Credentials: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:PO BOX 416457
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02241-6457
Mailing Address - Country:US
Mailing Address - Phone:844-362-1735
Mailing Address - Fax:973-290-7495
Practice Address - Street 1:831 TENNENT RD STE 1E
Practice Address - Street 2:
Practice Address - City:MANALAPAN
Practice Address - State:NJ
Practice Address - Zip Code:07726-8288
Practice Address - Country:US
Practice Address - Phone:732-851-4700
Practice Address - Fax:732-851-4703
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-26
Last Update Date:2025-01-24
Deactivation Date:2020-09-22
Deactivation Code:
Reactivation Date:2020-09-25
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ01048200363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner