Individual
MRS. AMY K MANGRUM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1100 NW 9TH PL, CAPE CORAL, FL 33993-6061
(123) 924-5403
Mailing address
1100 NW 9TH PL, CAPE CORAL, FL 33993-6061
(239) 245-4033
Taxonomy
Speciality
Code
Description
License number
State
171W00000X
Contractor
Primary
—
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
105007600
—
FL
Enumeration date
06/10/2020
Last updated
06/10/2020
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