Provider Demographics
NPI:1336122084
Name:MANGIONE, RICARDO ANTONIO (PA)
Entity Type:Individual
Prefix:MR
First Name:RICARDO
Middle Name:ANTONIO
Last Name:MANGIONE
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2995 DREW ST FL 2
Mailing Address - Street 2:
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33759-3012
Mailing Address - Country:US
Mailing Address - Phone:727-315-7469
Mailing Address - Fax:
Practice Address - Street 1:6200 SUNSET DR
Practice Address - Street 2:SUITE 403
Practice Address - City:SOUTH MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33143-4828
Practice Address - Country:US
Practice Address - Phone:305-740-8036
Practice Address - Fax:305-740-8137
Is Sole Proprietor?:No
Enumeration Date:2005-11-28
Last Update Date:2023-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9102135363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL292033600Medicaid
FL292033600Medicaid
P91391Medicare UPIN