Provider Demographics
NPI:1033488408
Name:MANGES, JESSICA JANE (ARNP)
Entity Type:Individual
Prefix:MS
First Name:JESSICA
Middle Name:JANE
Last Name:MANGES
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:202 LAKE MIRIAM DR
Mailing Address - Street 2:S-1
Mailing Address - City:LAKELAND
Mailing Address - State:FL
Mailing Address - Zip Code:33813-2180
Mailing Address - Country:US
Mailing Address - Phone:863-647-2333
Mailing Address - Fax:863-393-1995
Practice Address - Street 1:202 LAKE MIRIAM DR
Practice Address - Street 2:S-1
Practice Address - City:LAKELAND
Practice Address - State:FL
Practice Address - Zip Code:33813-2180
Practice Address - Country:US
Practice Address - Phone:863-647-2333
Practice Address - Fax:863-393-1995
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-14
Last Update Date:2011-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9254601363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health