Angel Renee Mantay, AGACNP-BC

Primary specialty

Acute Care Nurse PractitionerTaxonomy code 363LA2100X

License

0024175623 Issued in VA

Practice address

2800 Godwin Blvd FL 1
Suffolk, VA 23434-8038

Phone

(757) 934-4821

Fax

(757) 934-4276

NPI assigned

Nov 15, 2017

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 4

Addresses

Medicare fee-for-service enrollment

Enrolled in VA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Sentara Medical Group

  • Family Medicine Physician
  • Norfolk, VA
  • NPI 1265485270
  Medicare reassignment NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1510704000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1639958400000",
    "number": "1194238972",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2800 GODWIN BLVD FL 1",
            "city": "SUFFOLK",
            "state": "VA",
            "postal_code": "234348038",
            "telephone_number": "757-934-4821",
            "fax_number": "757-934-4276"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2800 GODWIN BLVD FL 1",
            "city": "SUFFOLK",
            "state": "VA",
            "postal_code": "234348038",
            "telephone_number": "757-934-4821",
            "fax_number": "757-934-4276"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1020 First Colonial Rd Ste A",
            "address_purpose": "LOCATION",
            "city": "Virginia Beach",
            "state": "VA",
            "postal_code": "23454",
            "country_code": "US",
            "telephone_number": "757-395-1850",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "2790 Godwin Blvd Ste 205",
            "address_purpose": "LOCATION",
            "city": "Suffolk",
            "state": "VA",
            "postal_code": "234348154",
            "country_code": "US",
            "telephone_number": "757-942-2566",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MANTAY",
        "first_name": "ANGEL",
        "middle_name": "RENEE",
        "credential": "AGACNP-BC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-11-15",
        "last_updated": "2021-12-20",
        "certification_date": "2021-12-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LA2200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Adult Health",
            "state": "VA",
            "license": "0024175623",
            "primary": false
        },
        {
            "code": "363LG0600X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Gerontology",
            "state": "VA",
            "license": "0024175623",
            "primary": false
        },
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "VA",
            "license": "0024175623",
            "primary": false
        },
        {
            "code": "363LA2100X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Acute Care",
            "state": "VA",
            "license": "0024175623",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Veronica Mary Malone, NP
• Iva Mananquil, LPTA
• Frank Smith Mancuso, MD
• Stacey Arleen Manley
• John Victor Mansoor, M.D.
• Vivian U Mapanao, MD
• Sandrine Laure Deighela Mapokam, FNP-BC
• Shaila Marcano-Stewart, COTA/L
• Aaron L Marlow, M.D.
• Desirae Jones Marshall, LPN

• Acute Care Nurse Practitioner in Suffolk, VA
• Providers in Suffolk, VA by specialty
• Acute Care Nurse Practitioner in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 20, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.