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General NPI Number Information
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NPI Number | 1215417068
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Entity Type | Individual
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Provider Name | LARRY JOSEPH MANGANELLO APRN
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Gender | Male
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Dates
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Enumeration Date | 08/20/2018
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Last Update Date | 01/24/2022
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Provider Practice Location Address
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Address Line | 3001 W DR MARTIN LUTHER KING JR BLVD
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City | TAMPA
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State | FL
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Zip | 33607-6307
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Country | US
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Telephone | 813-870-4000
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Fax |
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Provider Business Mailing Address
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Address Line | 3914 ROSWELL PL
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City | LAND O LAKES
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State | FL
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Zip | 34639-6206
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | APRN2519972
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 363LG0600X
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Taxonomy Name | Gerontology Nurse Practitioner
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License Number | APRN2519972
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License Number State | FL
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Taxonomy #3
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Taxonomy Code | 363LC0200X
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Taxonomy Name | Critical Care Medicine Nurse Practitioner
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License Number | APRN2519972
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License Number State | FL
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