Basic Information
| Provider Information | |||||||||
| NPI: | 1871901850 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MANGUS | ||||||||
| FirstName: | MARTHA | ||||||||
| MiddleName: | LEIGH | ||||||||
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| Credential: | ARNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3780 NW 83RD ST | ||||||||
| Address2: | S 114 | ||||||||
| City: | GAINESVILLE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 326065603 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3523772022 | ||||||||
| FaxNumber: | 3523779113 | ||||||||
| Practice Location | |||||||||
| Address1: | 3780 NW 83RD ST | ||||||||
| Address2: | S 114 | ||||||||
| City: | GAINESVILLE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 326065603 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3523772022 | ||||||||
| FaxNumber: | 3523779113 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/23/2014 | ||||||||
| LastUpdateDate: | 07/23/2014 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | ARNP9310043 | FL | Y | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.