Provider Demographics
NPI:1750984886
Name:MANGANELLO, JORDAN JARREAU (FNP-C)
Entity type:Individual
Prefix:MRS
First Name:JORDAN
Middle Name:JARREAU
Last Name:MANGANELLO
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3200 RESEARCH FOREST DR STE A4
Mailing Address - Street 2:
Mailing Address - City:THE WOODLANDS
Mailing Address - State:TX
Mailing Address - Zip Code:77381-4084
Mailing Address - Country:US
Mailing Address - Phone:281-297-6305
Mailing Address - Fax:
Practice Address - Street 1:3200 RESEARCH FOREST DR STE A4
Practice Address - Street 2:
Practice Address - City:THE WOODLANDS
Practice Address - State:TX
Practice Address - Zip Code:77381-4084
Practice Address - Country:US
Practice Address - Phone:281-297-6305
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-20
Last Update Date:2024-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA202488163W00000X, 363LF0000X
TX1099795363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse