Provider Demographics
NPI:1407273170
Name:MCMANUS, MIKAELA DIANA (PA-C)
Entity type:Individual
Prefix:MS
First Name:MIKAELA
Middle Name:DIANA
Last Name:MCMANUS
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:EL SALVADOR WAY
Mailing Address - Street 2:
Mailing Address - City:EGLIN AFB
Mailing Address - State:FL
Mailing Address - Zip Code:32542
Mailing Address - Country:US
Mailing Address - Phone:850-885-9979
Mailing Address - Fax:850-883-2429
Practice Address - Street 1:4152 EL SALVADOR WAY
Practice Address - Street 2:
Practice Address - City:EGLIN AFB
Practice Address - State:FL
Practice Address - Zip Code:32542
Practice Address - Country:US
Practice Address - Phone:508-855-9979
Practice Address - Fax:850-883-2429
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-19
Last Update Date:2025-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care