Provider Demographics
NPI:1750975116
Name:MANNS, TAMARA TARA (RN)
Entity type:Individual
Prefix:
First Name:TAMARA
Middle Name:TARA
Last Name:MANNS
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:TAMARA
Other - Middle Name:TARA
Other - Last Name:SMITH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:425 PLAZA CIR
Mailing Address - Street 2:
Mailing Address - City:BOSSIER CITY
Mailing Address - State:LA
Mailing Address - Zip Code:71111-4811
Mailing Address - Country:US
Mailing Address - Phone:419-307-4980
Mailing Address - Fax:
Practice Address - Street 1:537 CUMBERLAND DR
Practice Address - Street 2:
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71106-5919
Practice Address - Country:US
Practice Address - Phone:318-560-0409
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-25
Last Update Date:2021-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LARN150117163WP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0200XNursing Service ProvidersRegistered NursePediatrics