Active NPI
Olivia Maniotis, PA-C
- Physician Assistant
- Davie, FL
National Provider Identifier
1609401082
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- License
- PA9114891
- Practice address
- 3200 S University Dr
Davie, FL 33328-2018 - Phone
- (954) 262-1250
- NPI assigned
- Mar 6, 2020
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | PA9114891 | FL | Primary |
Addresses
Primary practice location
3200 S University Dr
Davie, FL 33328-2018
Mailing address
2532 Conroy Dr
West Palm Beach, FL 33403-1402
Phone (904) 343-5173
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 |
|---|---|---|---|
| PA9114891 | FL | MD | Physician Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1583452800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1704931200000",
"number": "1609401082",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2532 CONROY DR",
"city": "WEST PALM BEACH",
"state": "FL",
"postal_code": "334031402",
"telephone_number": "904-343-5173"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3200 S UNIVERSITY DR",
"city": "DAVIE",
"state": "FL",
"postal_code": "333282018",
"telephone_number": "954-262-1250"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MANIOTIS",
"first_name": "OLIVIA",
"credential": "PA-C",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2020-03-06",
"last_updated": "2024-01-11",
"certification_date": "2024-01-11",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "FL",
"license": "PA9114891",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Davie, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 11, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.