Provider Demographics
NPI:1508008319
Name:MANGOLD, JENNIFER (CRNP, FNP-BC)
Entity Type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:
Last Name:MANGOLD
Suffix:
Gender:F
Credentials:CRNP, FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1300 DOUGLAS CIR
Mailing Address - Street 2:
Mailing Address - City:KEY WEST
Mailing Address - State:FL
Mailing Address - Zip Code:33040-4536
Mailing Address - Country:US
Mailing Address - Phone:305-293-4862
Mailing Address - Fax:
Practice Address - Street 1:1600 KIRKWOOD HWY
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19805-4918
Practice Address - Country:US
Practice Address - Phone:302-633-5384
Practice Address - Fax:302-633-5384
Is Sole Proprietor?:No
Enumeration Date:2009-03-26
Last Update Date:2021-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP10248364SF0001X
DELG-0011856364SF0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SF0001XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistFamily Health