Manouchka L Etienne, PA-C

Primary specialty

Medical Physician AssistantTaxonomy code 363AM0700X

License

13129 Issued in GA

Practice address

1600 Ellis St
Brunswick, GA 31520-6737

Phone

(912) 289-2006

NPI assigned

Jun 9, 2025

Last updated

Jun 9, 2025By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in GA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Physician Assistant

Education

Other, 2024

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Coastal Community Health Services IncGroup PAC ID 0345463683, 54 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Southeast Georgia Health System- Brunswick Campus Hospital, Brunswick, GA, CCN 110025

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Coastal Community Health Services Inc

  • Federally Qualified Health Center (FQHC)
  • Brunswick, GA
  • NPI 1609298751
  Medicare reassignment Care Compare group NPD
• Coastal Community Health Services, Inc.

  dba Coastal Community Health - Pooler

  • Federally Qualified Health Center (FQHC)
  • Pooler, GA
  • NPI 1871350090
  NPD

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Southeast Georgia Health System, Inc.

  dba Southeast Georgia Health System - Brunswick Campus

  • General Acute Care Hospital
  • Brunswick, GA
  • NPI 1598784720
  Care Compare affiliation

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

{
    "created_epoch": "1749427200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1749427200000",
    "number": "1891680229",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6548 CONSTANCE ST",
            "city": "LAKE WORTH",
            "state": "FL",
            "postal_code": "334677660",
            "telephone_number": "561-307-7859",
            "fax_number": "561-307-7859"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1600 ELLIS ST",
            "city": "BRUNSWICK",
            "state": "GA",
            "postal_code": "315206737",
            "telephone_number": "912-289-2006"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ETIENNE",
        "first_name": "MANOUCHKA",
        "middle_name": "L",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2025-06-09",
        "last_updated": "2025-06-09",
        "certification_date": "2025-06-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "GA",
            "license": "13129",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Brendan Clark Engen, PSY.D.
• Enrique Martinez, M.D., P.C.
• Ergent Med Prime
• Ergent Med-1
• Ergent Med-1 LLC (ERgent Med-1)
• William C Everett, OD
• Excelarate Physical Therapy
• Expand Health, LLC
• Jennifer Faillace, CRNA
• Amy Hamm Faircloth, P.T.

• Medical Physician Assistant in Brunswick, GA
• Providers in Brunswick, GA by specialty
• Medical Physician Assistant in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 9, 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.