Individual
JACK EARL MANISCALCO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
2816 W VIRGINIA AVE, NEUROLOGICAL SPECIALTIES NEUROSURGERY PA, TAMPA, FL 33607-6330
(813) 876-6321
(813) 870-0350
Mailing address
2816 W VIRGINIA AVE, NEUROLOGICAL SPECIALTIES NEUROSURGERY PA, TAMPA, FL 33607-6330
(813) 876-6321
(813) 870-0350
Taxonomy
Speciality
Code
Description
License number
State
207T00000X
Neurological Surgery Physician
Primary
ME0023743
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
059512800
—
FL
01
—
406143136
RAILROAD MEDICARE
—
01
—
71703
BCBS
FL
01
—
F70917030
CHAMPUS
—
01
—
ME0023743
MEDICAL LICENSE
FL
Enumeration date
05/05/2006
Last updated
10/06/2014
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