| Manzanita Mind Institute Pllc | |
|
3075 N Swan Rd Ste 206 Tucson AZ 85712-1259 | |
| (520) 230-1065 | |
| Not Available |
| Full Name | Manzanita Mind Institute Pllc |
|---|---|
| Speciality | Nurse Practitioner |
| Location | 3075 N Swan Rd Ste 206, Tucson, Arizona |
| Authorized Official Name and Position | Jolene Jacquart (MEMBER) |
| Authorized Official Contact | 5102301065 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Manzanita Mind Institute Pllc 3075 N Swan Rd Ste 206 Tucson AZ 85712-1259 Ph: (520) 230-1065 | Manzanita Mind Institute Pllc 3075 N Swan Rd Ste 206 Tucson AZ 85712-1259 Ph: (520) 230-1065 |
| NPI Number | 1174385058 |
|---|---|
| Provider Enumeration Date | 01/26/2024 |
| Last Update Date | 01/26/2024 |
| Certification Date | 01/20/2024 |
| Medicare PECOS PAC ID | 4183164312 |
|---|---|
| Medicare Enrollment ID | O20240913002132 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1174385058 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103TB0200X | Psychologist - Cognitive & Behavioral | (* (Not Available)) | Secondary |
| 363LP0808X | Nurse Practitioner - Psychiatric/mental Health | (* (Not Available)) | Primary |
| Provider Name | Daniel Jon Lamanna |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1770065229 PECOS PAC ID: 7113350893 Enrollment ID: I20230912004378 |
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