Provider Demographics
NPI:1013942473
Name:MANGUAL, TAMMY LEA (DNP, ARNP-C)
Entity Type:Individual
Prefix:DR
First Name:TAMMY
Middle Name:LEA
Last Name:MANGUAL
Suffix:
Gender:F
Credentials:DNP, ARNP-C
Other - Prefix:
Other - First Name:TAMMY
Other - Middle Name:LEA
Other - Last Name:ARCHIBALD/CEBALLOS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:156 CLEMENTE DR
Mailing Address - Street 2:
Mailing Address - City:SATELLITE BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32937-5709
Mailing Address - Country:US
Mailing Address - Phone:321-432-0573
Mailing Address - Fax:
Practice Address - Street 1:11780 US HIGHWAY 1 STE N107
Practice Address - Street 2:
Practice Address - City:PALM BEACH GARDENS
Practice Address - State:FL
Practice Address - Zip Code:33408-3007
Practice Address - Country:US
Practice Address - Phone:321-449-6197
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-12
Last Update Date:2023-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL3311522363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL305303200Medicaid
FLE8528Medicare PIN