Provider Demographics
NPI:1326450834
Name:MANGUM, REBECCA (AP)
Entity Type:Individual
Prefix:MRS
First Name:REBECCA
Middle Name:
Last Name:MANGUM
Suffix:
Gender:F
Credentials:AP
Other - Prefix:MRS
Other - First Name:REBECCA
Other - Middle Name:LYNN
Other - Last Name:WAYNE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:AP
Mailing Address - Street 1:5201 SW 91ST DR
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32608-3018
Mailing Address - Country:US
Mailing Address - Phone:352-327-3561
Mailing Address - Fax:
Practice Address - Street 1:5201 SW 91ST DR
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32608-3018
Practice Address - Country:US
Practice Address - Phone:352-327-3561
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-06-02
Last Update Date:2014-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAP 3255171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist