Mandy, Deja

Mandy, Deja is an individual health care provider with primary practice located at 1839 Central Avenue , St Petersburg FL 33713-8900. She recently has only one registered license in Physician Assistants & Advanced Practice Nursing Providers / Gerontology, which is considered as her primary health care specialty. Mandy, Deja can be contacted via phone (727) 322-1054.

Contact Information

Primary practice address
1839 Central Avenue St Petersburg FL 33713-8900
Phone: (727) 322-1054
Fax: (727) 821-7213
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Physician Assistants & Advanced Practice Nursing Providers / Gerontology 363LG0600X APRN11023581 Florida

Profile Details

NPI number 1538926993
LBN Legal business name Mandy, Deja
Credentials Advanced Practice Registered Nurse (APRN)
Entity Individual
Sole proprietor 1 No
Enumeration date Mar 4th, 2024
Last updated May 24th, 2024 - about 2 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1538926993 NPPES
Florida MEDICAID 121835800
Florida Other 4EA8C

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