Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208000000X | Pediatrician | 25MA08713600 | NJ |
N | 208000000X | Pediatrician | ME121132 | FL |
Y | 2080P0204X | Pediatric Emergency Doctor | ME121132 | FL |
NPI | 1164667929 |
---|---|
Provider Name | Dr. Tia C. Manning |
First Address | Fort Myers, FL 33902-2147 |
Second Address | Fort Myers, FL 33908-3618 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/12/2008 |
Last Update Date | 05/04/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
013893700 | (05) | FL |