Healthcare Provider Details

I. General information

NPI: 1124944574
Provider Name (Legal Business Name): DANIELA MANTLE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/29/2026
Last Update Date: 06/29/2026
Certification Date: 06/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19347 US HIGHWAY 19 N APT 202
CLEARWATER FL
33764-3305
US

IV. Provider business mailing address

12901 BRUCE B DOWNS BLVD
TAMPA FL
33612-4742
US

V. Phone/Fax

Practice location:
  • Phone: 238-745-7744
  • Fax:
Mailing address:
  • Phone: 813-974-2191
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberRN9479086
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: