Healthcare Provider Details

I. General information

NPI: 1487942280
Provider Name (Legal Business Name): CARINA MANALO DNP, APRN, ACNP, FN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/13/2011
Last Update Date: 09/08/2025
Certification Date: 09/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1521 COOPER ST
FORT WORTH TX
76104-2711
US

IV. Provider business mailing address

3905 BAMBERG LN
FORT WORTH TX
76244-6049
US

V. Phone/Fax

Practice location:
  • Phone: 817-336-5864
  • Fax: 817-336-2159
Mailing address:
  • Phone: 817-817-9074
  • Fax: 817-741-5383

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number3-002450
License Number StateAL
# 2
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License NumberAP112667
License Number StateTX
# 3
Primary TaxonomyN
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number907694
License Number StateMS
# 4
Primary TaxonomyN
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number5022442
License Number StateNC
# 5
Primary TaxonomyN
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number041477964
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: