Provider Demographics
NPI:1881860963
Name:NANGLE, JOHN DUSTIN (PA-C)
Entity Type:Individual
Prefix:MR
First Name:JOHN
Middle Name:DUSTIN
Last Name:NANGLE
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2645 N FEDERAL HWY
Mailing Address - Street 2:
Mailing Address - City:DELRAY BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33483-6100
Mailing Address - Country:US
Mailing Address - Phone:561-742-2004
Mailing Address - Fax:
Practice Address - Street 1:2645 N FEDERAL HWY
Practice Address - Street 2:
Practice Address - City:DELRAY BEACH
Practice Address - State:FL
Practice Address - Zip Code:33483-6100
Practice Address - Country:US
Practice Address - Phone:561-742-2004
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-05-07
Last Update Date:2022-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9102535363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant