Provider Demographics
NPI:1033692900
Name:MANNING, KARLIE N
Entity type:Individual
Prefix:
First Name:KARLIE
Middle Name:N
Last Name:MANNING
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 312
Mailing Address - Street 2:
Mailing Address - City:SANDERSON
Mailing Address - State:FL
Mailing Address - Zip Code:32087-0312
Mailing Address - Country:US
Mailing Address - Phone:904-753-8100
Mailing Address - Fax:
Practice Address - Street 1:14052 FRIENDSHIP PL
Practice Address - Street 2:
Practice Address - City:SANDERSON
Practice Address - State:FL
Practice Address - Zip Code:32087-2489
Practice Address - Country:US
Practice Address - Phone:904-753-8100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-07
Last Update Date:2020-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
376K00000X
FL253J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide
No253J00000XAgenciesFoster Care Agency