Provider Demographics
NPI:1487942280
Name:MANALO, CARINA (DNP, APRN, ACNP, FN)
Entity type:Individual
Prefix:
First Name:CARINA
Middle Name:
Last Name:MANALO
Suffix:
Gender:F
Credentials:DNP, APRN, ACNP, FN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3905 BAMBERG LN
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76244-6049
Mailing Address - Country:US
Mailing Address - Phone:817-817-9074
Mailing Address - Fax:817-741-5383
Practice Address - Street 1:1521 COOPER ST
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76104-2711
Practice Address - Country:US
Practice Address - Phone:817-336-5864
Practice Address - Fax:817-336-2159
Is Sole Proprietor?:No
Enumeration Date:2011-07-13
Last Update Date:2025-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP112667363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care