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MR. THEODORE JONATHAN MANGRU ARNP

Physician Assistants & Advanced Practice Nursing Providers Nurse Practitioner Acute Care

Provider NPI: 1538318928

Provider Information:
MR. THEODORE JONATHAN MANGRU ARNP
Gender: M
Not Sole Proprietor

Practice Location:
1000 PARK CENTRE BLVD SUITE 136 MIAMI GARDENS, FL 33169-5373 US
Tel: 305-628-6138  Fax: 305-290-3216

Business Mailing Address:
375 NE 164TH TER  NORTH MIAMI BEACH, FL 33162-3541 US
Tel: 305-439-7987  Fax: --

NPI Information:
NPI: 1538318928
Entity Type: Individual

Taxonomy:

PrimaryCodeCategory/DescriptionStateLicense Number
Y363LA2100XPhysician Assistants & Advanced Practice Nursing Providers
Nurse Practitioner
Acute Care
FL2913662
N364SA2100XPhysician Assistants & Advanced Practice Nursing Providers
Clinical Nurse Specialist
GARN186059

Other Provider Identifiers:

IssuerNumberStateType



American Medical Association 2012 taxonomy code information

Code: 363LA2100X

Type:

Classification:



Definition:



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