Provider Demographics
NPI:1144801846
Name:MANGANO, SARA BELLA (CRNP)
Entity Type:Individual
Prefix:
First Name:SARA
Middle Name:BELLA
Last Name:MANGANO
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:SARA
Other - Middle Name:BELLA
Other - Last Name:MANGANO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:BSN, MSN, RN, FNP-BC
Mailing Address - Street 1:833 CHESTNUT ST STE 204
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19107-4414
Mailing Address - Country:US
Mailing Address - Phone:215-503-7573
Mailing Address - Fax:
Practice Address - Street 1:833 CHESTNUT ST STE 204
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19107-4414
Practice Address - Country:US
Practice Address - Phone:215-503-7573
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-15
Last Update Date:2021-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP021804363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily