MEDICARE: VANITA MAHAN ARNP

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	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	ARNP1655502	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1922017540
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	VANITA MAHAN ARNP

Provider Business Mailing Address
First Line	:	2824 WINDGUARD CIR
Second Line	:	SUITE 101
City	:	WESLEY CHAPEL
State	:	FL
Zip	:	33544-7369
Country	:	US
Telephone Number	:	813-731-2966
Fax Number	:	352-567-5193

Provider Business Practice Location Address
First Line	:	2824 WINDGUARD CIR
Second Line	:	SUITE 101
City	:	WESLEY CHAPEL
State	:	FL
Zip	:	33544-7369
Country	:	US
Telephone Number	:	813-731-2966
Fax Number	:	352-567-5193

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

Provider Enumeration Date	:	08/05/2006
Last Update Date	:	12/02/2016

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