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General NPI Number Information
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NPI Number | 1508008319
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Entity Type | Individual
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Provider Name | JENNIFER MANGOLD CRNP, FNP-BC
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Gender | Female
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Dates
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Enumeration Date | 03/26/2009
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Last Update Date | 12/29/2021
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Provider Practice Location Address
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Address Line | 1600 KIRKWOOD HWY
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City | WILMINGTON
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State | DE
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Zip | 19805-4918
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Country | US
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Telephone | 302-633-5384
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Fax | 302-633-5384
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Provider Business Mailing Address
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Address Line | 1300 DOUGLAS CIR
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City | KEY WEST
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State | FL
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Zip | 33040-4536
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Country | US
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Telephone | 305-293-4862
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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 | 364SF0001X
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Taxonomy Name | Family Health Clinical Nurse Specialist
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License Number | SP10248
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License Number State | PA
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Taxonomy #2
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Taxonomy Code | 364SF0001X
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Taxonomy Name | Family Health Clinical Nurse Specialist
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License Number | LG-0011856
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License Number State | DE
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