Provider Demographics
NPI:1588234322
Name:MANGAT, SHANNON BROOKE (FNP-C)
Entity Type:Individual
Prefix:
First Name:SHANNON
Middle Name:BROOKE
Last Name:MANGAT
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:750 W HAMPDEN AVE STE 105
Mailing Address - Street 2:
Mailing Address - City:ENGLEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80110-2167
Mailing Address - Country:US
Mailing Address - Phone:303-341-4730
Mailing Address - Fax:303-341-4708
Practice Address - Street 1:13650 E MISSISSIPPI AVE STE 100B
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80012-3573
Practice Address - Country:US
Practice Address - Phone:303-695-1338
Practice Address - Fax:303-695-8814
Is Sole Proprietor?:No
Enumeration Date:2021-06-24
Last Update Date:2021-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COAPN.0996619-NP363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily