Active NPI
Jacqueline M. La Manna, ARNP
- Nurse Practitioner
- Melbourne, FL
National Provider Identifier
1609287507
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Nurse Practitioner
- License
- ARNP1636342
- Practice address
- 2275 S. Babcock St.
Melbourne, FL 32901-5305 - Phone
- (321) 726-2925
- Fax
- (321) 984-4825
- NPI assigned
- May 13, 2014
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Public Health or Welfare Agency | 251K00000X | |||
| Nurse Practitioner | 363L00000X | ARNP1636342 | FL | Primary |
Addresses
Primary practice location
2275 S. Babcock St.
Melbourne, FL 32901-5305
Mailing address
2575 N. Courtenay Pkwy
Merritt Island, FL 32953
Phone (321) 454-7148
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| ARNP1636342 | FL | MD | Nurse Practitioner |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Florida Department of Health | Public Health Or Welfare | Past | Accepting new patients |
Organizations & group practices 1
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.
-
dba Brevard County Health Department
- Public Health or Welfare Agency
- Viera, FL
- NPI 1386751907
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1399939200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1399939200000",
"number": "1609287507",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2575 N. COURTENAY PKWY",
"city": "MERRITT ISLAND",
"state": "FL",
"postal_code": "32953",
"telephone_number": "321-454-7148",
"fax_number": "321-449-5015"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2275 S. BABCOCK ST.",
"city": "MELBOURNE",
"state": "FL",
"postal_code": "329015305",
"telephone_number": "321-726-2925",
"fax_number": "321-984-4825"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LA MANNA",
"first_name": "JACQUELINE",
"middle_name": "M.",
"credential": "ARNP",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2014-05-13",
"last_updated": "2014-05-13",
"status": "A"
},
"taxonomies": [
{
"code": "251K00000X",
"taxonomy_group": "",
"desc": "Public Health or Welfare",
"state": null,
"license": null,
"primary": false
},
{
"code": "363L00000X",
"taxonomy_group": "",
"desc": "Nurse Practitioner",
"state": "FL",
"license": "ARNP1636342",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Melbourne, FL
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Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 13, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.