Provider Demographics
NPI:1487302410
Name:MANZANO, MARISOL (RN)
Entity type:Individual
Prefix:
First Name:MARISOL
Middle Name:
Last Name:MANZANO
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:278 LASALLE LEFALL DR
Mailing Address - Street 2:
Mailing Address - City:QUINCY
Mailing Address - State:FL
Mailing Address - Zip Code:32351-5324
Mailing Address - Country:US
Mailing Address - Phone:850-743-6042
Mailing Address - Fax:850-875-7216
Practice Address - Street 1:278 LASALLE LEFALL DR
Practice Address - Street 2:
Practice Address - City:QUINCY
Practice Address - State:FL
Practice Address - Zip Code:32351-5324
Practice Address - Country:US
Practice Address - Phone:850-743-6042
Practice Address - Fax:850-875-7216
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-18
Last Update Date:2022-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRN9591849163W00000X, 163WC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC1500XNursing Service ProvidersRegistered NurseCommunity Health
No163W00000XNursing Service ProvidersRegistered Nurse