Mervin Punzalan Manuel, M.D.

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

License

ME123580 Issued in FL

Practice address

1463 Nectarine St
Fernandina Beach, FL 32034-3027

Phone

(904) 491-0177

Fax

(904) 491-3173

NPI assigned

Feb 15, 2007

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 2

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in FL

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• North Okaloosa Clinic Corp

  • Internal Medicine Physician
  • Crestview, FL
  • NPI 1659329852

  Pediatrics

  Medicare reassignment NPD
• Trenton Medical Center Inc

  • Federally Qualified Health Center (FQHC)
  • Trenton, FL
  • NPI 1801826268
  Medicare reassignment NPD
• North Okaloosa Clinic Corp

  • Durable Medical Equipment & Medical Supplies
  • Crestview, FL
  • NPI 1477738896
  NPD
• Trenton Medical Center, Inc.

  • Federally Qualified Health Center (FQHC)
  • Fleming Island, FL
  • NPI 1275220238
  NPD
• White-Wilson Medical Center PA

  • Clinic/Center
  • Fort Walton Beach, FL
  • NPI 1467437277
  NPD
• Saltzman, Tanis, Pittell, Levin and Jacobson

  • Pediatrics Physician
  • Hollywood, FL
  • NPI 1639138480
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1171497600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1747267200000",
    "number": "1215070396",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "900 S PINE ISLAND RD STE 800",
            "city": "PLANTATION",
            "state": "FL",
            "postal_code": "333243923",
            "telephone_number": "904-491-0177",
            "fax_number": "904-491-3173"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1463 NECTARINE ST",
            "city": "FERNANDINA BEACH",
            "state": "FL",
            "postal_code": "320343027",
            "telephone_number": "904-491-0177",
            "fax_number": "904-491-3173"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MANUEL",
        "first_name": "MERVIN",
        "middle_name": "PUNZALAN",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-02-15",
        "last_updated": "2025-05-15",
        "certification_date": "2025-05-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "FL",
            "license": "ME123580",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "016615600",
            "state": "FL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "102682978",
            "state": "PA"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "mervin.manuel.1@1523.direct.athenahealth.com",
            "affiliation": "N",
            "endpointDescription": "AMR direct address",
            "address_1": "130 E Redstone Ave",
            "city": "Crestview",
            "state": "FL",
            "country_code": "US",
            "postal_code": "325395348",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Andrew Dean Magnet, MD, PHD
• Magnolia Grace Senior Care LLC
• Annette R Maguire, M.S.
• Patricia Ann Magyari, M.S.
• Chloelynn Malonzo
• James Marino, RPT
• Katelyn Marie Marks, OD
• Carmita Marrero, M.D.
• Kimberlyann Marsden, PH.D.
• Courtney Marshall, PA-C

• Pediatrics Physician in Fernandina Beach, FL
• Providers in Fernandina Beach, FL by specialty
• Pediatrics Physician in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 15, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.