Provider Demographics
NPI:1871901850
Name:MANGUS, MARTHA LEIGH (ARNP)
Entity type:Individual
Prefix:
First Name:MARTHA
Middle Name:LEIGH
Last Name:MANGUS
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:3780 NW 83RD ST
Mailing Address - Street 2:S 114
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32606-5603
Mailing Address - Country:US
Mailing Address - Phone:352-377-2022
Mailing Address - Fax:352-377-9113
Practice Address - Street 1:3780 NW 83RD ST
Practice Address - Street 2:S 114
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32606-5603
Practice Address - Country:US
Practice Address - Phone:352-377-2022
Practice Address - Fax:352-377-9113
Is Sole Proprietor?:No
Enumeration Date:2014-07-23
Last Update Date:2014-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9310043207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine