Provider Demographics
NPI:1699108902
Name:MANIGLIA, TAMMY JO (RN)
Entity type:Individual
Prefix:
First Name:TAMMY
Middle Name:JO
Last Name:MANIGLIA
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8021 CRESTWOOD DR
Mailing Address - Street 2:
Mailing Address - City:GARRETTSVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:44231-1024
Mailing Address - Country:US
Mailing Address - Phone:330-527-4614
Mailing Address - Fax:
Practice Address - Street 1:8021 CRESTWOOD DR
Practice Address - Street 2:
Practice Address - City:GARRETTSVILLE
Practice Address - State:OH
Practice Address - Zip Code:44231-1024
Practice Address - Country:US
Practice Address - Phone:330-527-4614
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-11
Last Update Date:2013-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN393808163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse