Individual
MR. LARRY JOSEPH MANGANELLO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
APRN
Contact information
Practice address
3001 W DR MARTIN LUTHER KING JR BLVD, TAMPA, FL 33607-6307
(813) 870-4000
Mailing address
3914 ROSWELL PL, LAND O LAKES, FL 34639-6206
Taxonomy
Speciality
Code
Description
License number
State
363LC0200X
Critical Care Medicine Nurse Practitioner
Primary
APRN2519972
FL
363LF0000X
Family Nurse Practitioner
APRN2519972
FL
363LG0600X
Gerontology Nurse Practitioner
APRN2519972
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
103924800
—
FL
01
—
H69WA
BLUE CROSS BLUE SHIELD
FL
Enumeration date
08/20/2018
Last updated
01/24/2022
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