| Doctor Name: | MS. TAMMY LEA MANGUAL |
| NPI Number: | 1013942473 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | ARNP-C |
| License Number: | 3311522 |
| Business Practice Address: | 3661 S Babcock St Suite 115 Melbourne, FL - 329018205 |
| Business Phone Number: | 3214347000 |
| Business Fax Number: | |
| Mailing Address: | 4221 Brantley Cir, ROCKLEDGE |
| State: | FL |
| Postal Code: | 329554770 |
| Phone Number: | 3214320573 |
| Fax Number: | |
| NPI Enumeration Date: | 07/12/2006 |
| NPI Last Update Date: | 12/16/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LA2200X |
| License Number: | 3311522 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | FL |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Adult Health |
| Taxonomy Definition: | |