Provider Demographics
NPI:1730870379
Name:MANTYH, EMMA (PA-C)
Entity type:Individual
Prefix:
First Name:EMMA
Middle Name:
Last Name:MANTYH
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 1:641 UNIVERSITY BLVD STE 211
Mailing Address - Street 2:
Mailing Address - City:JUPITER
Mailing Address - State:FL
Mailing Address - Zip Code:33458-2794
Mailing Address - Country:US
Mailing Address - Phone:561-267-5056
Mailing Address - Fax:
Practice Address - Street 1:641 UNIVERSITY BLVD STE 211
Practice Address - Street 2:
Practice Address - City:JUPITER
Practice Address - State:FL
Practice Address - Zip Code:33458-2794
Practice Address - Country:US
Practice Address - Phone:561-253-8121
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-16
Last Update Date:2024-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9117312363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant