Provider Demographics
NPI:1083252845
Name:MANCO, CARA (APRN)
Entity type:Individual
Prefix:MRS
First Name:CARA
Middle Name:
Last Name:MANCO
Suffix:
Gender:
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 748817
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30374-8817
Mailing Address - Country:US
Mailing Address - Phone:813-286-0033
Mailing Address - Fax:813-282-1806
Practice Address - Street 1:515 SOUTH KINGS AVENUE
Practice Address - Street 2:UNIT 10,000 SUITE 1300
Practice Address - City:BRANDON
Practice Address - State:FL
Practice Address - Zip Code:33511
Practice Address - Country:US
Practice Address - Phone:813-571-2777
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-12-11
Last Update Date:2025-02-25
Deactivation Date:2023-01-26
Deactivation Code:
Reactivation Date:2025-02-18
Provider Licenses
StateLicense IDTaxonomies
FL11005227363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily