MEDICARE: JENNA MANGAS

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	363A00000X	Physician Assistant

General Provider Information

NPI Number	:	1710837901
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENNA MANGAS

Provider Business Mailing Address
First Line	:	135 W ELM ST
Second Line	:
City	:	DESHLER
State	:	OH
Zip	:	43516-1106
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	12817 PARKVIEW PLAZA DR
Second Line	:
City	:	FORT WAYNE
State	:	IN
Zip	:	46845-1741
Country	:	US
Telephone Number	:	260-702-8014
Fax Number	:

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

Provider Enumeration Date	:	01/29/2026
Last Update Date	:	01/29/2026

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Directions to “ JENNA MANGAS ” Practice Location

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