Organization
MANTIS MEDICAL PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TANISHA MANGON (OWNER)
(832) 334-8427
Entity
Organization
Contact information
Practice address
14090 SOUTHWEST FWY STE 300, SUGAR LAND, TX 77478-3679
(281) 524-8902
(281) 805-1386
Mailing address
12202 QUIET MEADOW CT, MEADOWS PLACE, TX 77477-2258
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
—
—
363LA2200X
Adult Health Nurse Practitioner
Primary
—
—
363LG0600X
Gerontology Nurse Practitioner
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1770896953
—
TX
Enumeration date
04/03/2025
Last updated
07/11/2025
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