Provider Demographics
NPI:1265819932
Name:NANGLE, AMBER (MS)
Entity Type:Individual
Prefix:
First Name:AMBER
Middle Name:
Last Name:NANGLE
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:AMBER
Other - Middle Name:
Other - Last Name:EVANS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:10810 BOYETTE RD # 2673
Mailing Address - Street 2:
Mailing Address - City:RIVERVIEW
Mailing Address - State:FL
Mailing Address - Zip Code:33569-8000
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:10810 BOYETTE RD # 2673
Practice Address - Street 2:
Practice Address - City:RIVERVIEW
Practice Address - State:FL
Practice Address - Zip Code:33569-8000
Practice Address - Country:US
Practice Address - Phone:813-525-7680
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-05-01
Last Update Date:2021-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLIMH 11911101YM0800X
FLMH13957101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health