Provider Demographics
NPI:1962663849
Name:MANZO, MALINDA (APN)
Entity Type:Individual
Prefix:
First Name:MALINDA
Middle Name:
Last Name:MANZO
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2860 COVINGTON PIKE
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38128-8090
Mailing Address - Country:US
Mailing Address - Phone:901-252-6034
Mailing Address - Fax:901-252-6048
Practice Address - Street 1:3161 HIGHWAY 64
Practice Address - Street 2:SUITE 100
Practice Address - City:EADS
Practice Address - State:TN
Practice Address - Zip Code:38028-3021
Practice Address - Country:US
Practice Address - Phone:901-252-6034
Practice Address - Fax:901-252-6048
Is Sole Proprietor?:No
Enumeration Date:2008-06-23
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TN011741363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNMM1339527OtherDEA