Provider Demographics
NPI:1790181527
Name:MANGABADI, KIMBERLY (ARNP)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:
Last Name:MANGABADI
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15049 SW 9TH WAY
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33194-2475
Mailing Address - Country:US
Mailing Address - Phone:305-335-3575
Mailing Address - Fax:
Practice Address - Street 1:15049 SW 9TH WAY
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33194-2475
Practice Address - Country:US
Practice Address - Phone:305-335-3575
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-11-05
Last Update Date:2022-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9289640363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner