Organization
MD-PRAC LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
NAOMI MANNING (CONSULTANT)
(833) 245-5633
Entity
Organization
Contact information
Practice address
1860 SW FOUNTAINVIEW BLVD STE 100, PORT ST LUCIE, FL 34986-4528
(833) 245-5633
(833) 962-6213
Mailing address
4662 SW BRADBURY ST, PORT ST LUCIE, FL 34953-5563
(833) 245-5633
(933) 962-6213
Taxonomy
Speciality
Code
Description
License number
State
171W00000X
Contractor
Primary
—
—
Other
Enumeration date
03/15/2022
Last updated
03/15/2022
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