Provider Demographics
NPI:1730684655
Name:ARANZASO, MARISSA MANANSALA (ARNP)
Entity type:Individual
Prefix:
First Name:MARISSA
Middle Name:MANANSALA
Last Name:ARANZASO
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3524 SILVER BLUFF BLVD
Mailing Address - Street 2:
Mailing Address - City:ORANGE PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32065-5257
Mailing Address - Country:US
Mailing Address - Phone:904-571-8959
Mailing Address - Fax:
Practice Address - Street 1:558 ABBOTT ST STE A
Practice Address - Street 2:
Practice Address - City:SALINAS
Practice Address - State:CA
Practice Address - Zip Code:93901-4326
Practice Address - Country:US
Practice Address - Phone:831-755-7880
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-25
Last Update Date:2024-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9294713363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily