Organization Name: | MANATEE MEMORIAL |
NPI Number: | 1013213065 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | ERICA MARIE-TYNE DISANTO (ARNP-C) |
Mailing Address: | 206 2nd St E Bradenton |
State: | FL US |
Postal Code: | 342081042 |
Phone Number: | 9417457419 |
Fax Number: | |
NPI Enumeration Date: | 02/08/2011 |
NPI Last Update Date: | 02/08/2011 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363LF0000X |
License Number: | 9227132 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | FL |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Nurse Practitioner |
Taxonomy Specialization: | Family |
Taxonomy Definition: |