Provider Demographics
NPI:1881041846
Name:MANZO, LAUREN MCCARTNEY (AGPCNP-BC)
Entity Type:Individual
Prefix:
First Name:LAUREN
Middle Name:MCCARTNEY
Last Name:MANZO
Suffix:
Gender:F
Credentials:AGPCNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7156 BIDWELL RD
Mailing Address - Street 2:
Mailing Address - City:JOELTON
Mailing Address - State:TN
Mailing Address - Zip Code:37080-8609
Mailing Address - Country:US
Mailing Address - Phone:731-780-6070
Mailing Address - Fax:216-781-9597
Practice Address - Street 1:5003 CROSSINGS CIR STE 103
Practice Address - Street 2:
Practice Address - City:MT JULIET
Practice Address - State:TN
Practice Address - Zip Code:37122-8583
Practice Address - Country:US
Practice Address - Phone:615-754-7274
Practice Address - Fax:216-781-9597
Is Sole Proprietor?:No
Enumeration Date:2016-05-19
Last Update Date:2023-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN20789363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner