Individual
DR. NICOLE LORIN MANNIS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PSY.D.
Contact information
Practice address
4689 TIMBERLANE RD, BASCOM, FL 32423-9425
(850) 557-7575
Mailing address
4689 TIMBERLANE RD, BASCOM, FL 32423-9425
(850) 557-7575
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
8081
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
491469300
—
MO
Enumeration date
05/14/2007
Last updated
05/19/2010
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