MEDICARE: AMBER NANGLE M.S.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor	IMH 11911	FL
2	101YM0800X	Mental Health Counselor	MH13957	FL

General Provider Information

NPI Number	:	1265819932
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AMBER NANGLE M.S.

Provider Business Mailing Address
First Line	:	10810 BOYETTE RD # 2673
Second Line	:
City	:	RIVERVIEW
State	:	FL
Zip	:	33569-8000
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	10810 BOYETTE RD # 2673
Second Line	:
City	:	RIVERVIEW
State	:	FL
Zip	:	33569-8000
Country	:	US
Telephone Number	:	813-525-7680
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/01/2015
Last Update Date	:	05/18/2021

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Directions to “ AMBER NANGLE M.S.” Practice Location

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