Provider Demographics
NPI:1922017540
Name:MAHAN, VANITA (ARNP)
Entity Type:Individual
Prefix:
First Name:VANITA
Middle Name:
Last Name:MAHAN
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 1:2824 WINDGUARD CIR
Mailing Address - Street 2:SUITE 101
Mailing Address - City:WESLEY CHAPEL
Mailing Address - State:FL
Mailing Address - Zip Code:33544-7369
Mailing Address - Country:US
Mailing Address - Phone:813-731-2966
Mailing Address - Fax:352-567-5193
Practice Address - Street 1:2824 WINDGUARD CIR
Practice Address - Street 2:SUITE 101
Practice Address - City:WESLEY CHAPEL
Practice Address - State:FL
Practice Address - Zip Code:33544-7369
Practice Address - Country:US
Practice Address - Phone:813-731-2966
Practice Address - Fax:352-567-5193
Is Sole Proprietor?:No
Enumeration Date:2006-08-05
Last Update Date:2016-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP1655502363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL034242400Medicaid
FL034242400Medicaid