Healthcare Provider Details

I. General information

NPI: 1265819932
Provider Name (Legal Business Name): AMBER NANGLE M.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: AMBER EVANS

II. Dates (important events)

Enumeration Date: 05/01/2015
Last Update Date: 05/18/2021
Certification Date: 05/18/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10810 BOYETTE RD # 2673
RIVERVIEW FL
33569-8000
US

IV. Provider business mailing address

10810 BOYETTE RD # 2673
RIVERVIEW FL
33569-8000
US

V. Phone/Fax

Practice location:
  • Phone: 813-525-7680
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberIMH 11911
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMH13957
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: