Individual provider Active NPI

Alice Bertha Manley, ARNP

  • Pediatric Nurse Practitioner
  • Auburndale, FL
National Provider Identifier
1477541936
Registry record updated Aug 11, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric Nurse PractitionerTaxonomy code 363LP0200X
License
ARNP127374 Issued in FL
Practice address
1805 Hobbs Rd
Auburndale, FL 33823-4644
Phone
(863) 965-5400
Fax
(863) 965-3739
NPI assigned
Oct 10, 2005
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 11, 2010

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatric Nurse Practitioner 363LP0200X ARNP127374 FL Primary

Addresses

Primary practice location

1805 Hobbs Rd
Auburndale, FL 33823-4644

Mailing address

1290 Golfview Ave
4TH Floor Attn Billing Department
Bartow, FL 33830-6738
Phone (863) 519-7900

Other identifiers 1

IdentifierTypeStateIssuer
034043000MedicaidFL

Other names 1

  • Alice Bertha Stanfield Other name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
ARNP127374FLMDPediatric Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
University Medical Service Association Inc Past Accepting new patients
Florida Department of Health Past Accepting new patients
Florida Department of Health PastSince Oct 1, 2000 Accepting new patients

Organizations & group practices 3

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.

NPI Registry JSON

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

{
    "created_epoch": "1128902400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1281484800000",
    "number": "1477541936",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1290 GOLFVIEW AVE",
            "address_2": "4TH FLOOR ATTN BILLING DEPARTMENT",
            "city": "BARTOW",
            "state": "FL",
            "postal_code": "338306738",
            "telephone_number": "863-519-7900",
            "fax_number": "863-519-7696"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1805 HOBBS RD",
            "city": "AUBURNDALE",
            "state": "FL",
            "postal_code": "338234644",
            "telephone_number": "863-965-5400",
            "fax_number": "863-965-3739"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MANLEY",
        "first_name": "ALICE",
        "middle_name": "BERTHA",
        "credential": "ARNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2005-10-10",
        "last_updated": "2010-08-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Pediatrics",
            "state": "FL",
            "license": "ARNP127374",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "034043000",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "ALICE",
            "last_name": "STANFIELD",
            "middle_name": "BERTHA",
            "credential": "ARNP",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Auburndale, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 11, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.