Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LW0102X | Nurse Practitioner - Women's Health | RN117197 | GA |
NPI | 1043359250 |
---|---|
Provider Name | Naquita Jackson Manning |
First Address | Patrick Afb, FL 32925-3606 |
Second Address | Patrick Afb, FL 32925-3606 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/02/2007 |
Last Update Date | 25/08/2015 |