Individual
DEJA MANDY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
APRN
Contact information
Practice address
1839 CENTRAL AVENUE, ST PETERSBURG, FL 33713-8900
(727) 322-1054
(727) 821-7213
Mailing address
1839 CENTRAL AVENUE, ST PETERSBURG, FL 33713-8900
(727) 322-1054
(727) 821-7213
Taxonomy
Speciality
Code
Description
License number
State
363LG0600X
Gerontology Nurse Practitioner
Primary
APRN11023581
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
121835800
—
FL
01
—
4EA8C
BCBS
FL
Enumeration date
03/04/2024
Last updated
05/24/2024
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