Provider Demographics
NPI:1912397530
Name:MANGUM, CHELSIE KAYTEN (ARNP)
Entity Type:Individual
Prefix:MRS
First Name:CHELSIE
Middle Name:KAYTEN
Last Name:MANGUM
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 1:8751 COMMODITY CIR
Mailing Address - Street 2:SUITE 10
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32819-9027
Mailing Address - Country:US
Mailing Address - Phone:407-345-5055
Mailing Address - Fax:
Practice Address - Street 1:704 GENERATION PT
Practice Address - Street 2:SUITE 201
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34744-5918
Practice Address - Country:US
Practice Address - Phone:888-644-1448
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-02-03
Last Update Date:2017-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP 9318711363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily