Provider Demographics
NPI:1619724226
Name:MEHTA, MANJULA (RN CCM)
Entity type:Individual
Prefix:
First Name:MANJULA
Middle Name:
Last Name:MEHTA
Suffix:
Gender:F
Credentials:RN CCM
Other - Prefix:
Other - First Name:JULIE
Other - Middle Name:
Other - Last Name:MEHTA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RN CCM
Mailing Address - Street 1:8879 MUGNAI ST
Mailing Address - Street 2:
Mailing Address - City:RIVERVIEW
Mailing Address - State:FL
Mailing Address - Zip Code:33578-5097
Mailing Address - Country:US
Mailing Address - Phone:813-686-4725
Mailing Address - Fax:
Practice Address - Street 1:8879 MUGNAI ST
Practice Address - Street 2:
Practice Address - City:RIVERVIEW
Practice Address - State:FL
Practice Address - Zip Code:33578-5097
Practice Address - Country:US
Practice Address - Phone:813-686-4725
Practice Address - Fax:770-723-5277
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-01
Last Update Date:2024-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRN9355459163WC0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC0400XNursing Service ProvidersRegistered NurseCase Management