Individual provider Active NPI

Larry Joseph Manganello, APRN

  • Critical Care Medicine Nurse Practitioner
  • Tampa, FL
National Provider Identifier
1215417068
Registry record updated Jan 24, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Critical Care Medicine Nurse PractitionerTaxonomy code 363LC0200X
License
APRN2519972 Issued in FL
Practice address
3001 W Dr Martin Luther King Jr Blvd
Tampa, FL 33607-6307
Phone
(813) 870-4000
NPI assigned
Aug 20, 2018
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 24, 2022

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X APRN2519972 FL
Gerontology Nurse Practitioner 363LG0600X APRN2519972 FL
Critical Care Medicine Nurse Practitioner 363LC0200X APRN2519972 FL Primary

Addresses

Primary practice location

3001 W Dr Martin Luther King Jr Blvd
Tampa, FL 33607-6307

Mailing address

3914 Roswell PL
Land O Lakes, FL 34639-6206

Other practice location 1

2 Tampa General Cir
Tampa, FL 33606-3571
Phone (813) 821-8038

Other identifiers 2

IdentifierTypeStateIssuer
H69WAOtherFLBLUE CROSS BLUE SHIELD
103924800MedicaidFL

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address lmanganello136486@direct.tgh.org

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL
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

Enrollment IDStateProvider typePAC IDDetails
I20190228001195 FL Practitioner - Nurse Practitioner 6507105046 Reassigns benefits to 4 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2018
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Florida Hospital Physician Group IncGroup PAC ID 2365679057, 953 clinicians

Practice addresses (Care Compare)

2700 Healing Way
Suite 308
Wesley Chapel, FL 33543-5492
Phone (813) 929-5226

Hospital & facility affiliations

  • Adventhealth Wesley Chapel Hospital, Wesley Chapel, FL, CCN 100319

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Adventist Health System-Sunbelt Inc Family CurrentSince Feb 1, 2022 Accepting new patients
Sound Physicians of Florida IV, LLC CurrentSince Sep 1, 2019 Accepting new patients
Florida Hospital Physician Group Inc Family CurrentSince Feb 1, 2022 Accepting new patients
Cogent Healthcare of Jacksonville, LLC CurrentSince Jan 15, 2019 Accepting new patients
Sound Physicians of Florida IV, LLC CurrentSince Sep 1, 2019 Accepting new patients
Cogent Healthcare of Jacksonville, LLC CurrentSince Jan 15, 2019 Accepting new patients
Adventist Health System-Sunbelt Inc CurrentSince Feb 1, 2022 Accepting new patients

Locations

655 W 8th St
Jacksonville, FL 32209
Phone (904) 244-1680

1210 US Highway 27 N
Lake Placid, FL 33852
Phone (863) 465-3777

4200 Sun N Lake Blvd
Sebring, FL 33872
Phone (863) 314-4406

3100 E Fletcher Ave
#C
Tampa, FL 33613

3100 E Fletcher Ave
Tampa, FL 33613
Phone (813) 615-7200

13901 Bruce B Downs Blvd
Tampa, FL 33613
Phone (813) 615-7260

2700 Healing Way
Ste 310
Wesley Chapel, FL 33543
Phone (813) 779-1209

2700 Healing Way
Ste 308
Wesley Chapel, FL 33543
Phone (813) 929-5226

5410 Maryland Way
Ste 300
Brentwood, TN 37027
Phone (615) 377-1674

Networks

  • Freedom Health HMO Network

Interoperability endpoints

  • Direct secure messaging: lmanganello136486@direct.tgh.org

Organizations & group practices 7

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.

Hospital & facility affiliations 1

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1534723200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1642982400000",
    "number": "1215417068",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3914 ROSWELL PL",
            "city": "LAND O LAKES",
            "state": "FL",
            "postal_code": "346396206"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3001 W DR MARTIN LUTHER KING JR BLVD",
            "city": "TAMPA",
            "state": "FL",
            "postal_code": "336076307",
            "telephone_number": "813-870-4000"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2 Tampa General Cir",
            "address_purpose": "LOCATION",
            "city": "Tampa",
            "state": "FL",
            "postal_code": "336063571",
            "country_code": "US",
            "telephone_number": "813-821-8038",
            "fax_number": "813-974-4325",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MANGANELLO",
        "first_name": "LARRY",
        "middle_name": "JOSEPH",
        "name_prefix": "Mr.",
        "credential": "APRN",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2018-08-20",
        "last_updated": "2022-01-24",
        "certification_date": "2022-01-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "FL",
            "license": "APRN2519972",
            "primary": false
        },
        {
            "code": "363LG0600X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Gerontology",
            "state": "FL",
            "license": "APRN2519972",
            "primary": false
        },
        {
            "code": "363LC0200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Critical Care Medicine",
            "state": "FL",
            "license": "APRN2519972",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "H69WA",
            "state": "FL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "103924800",
            "state": "FL"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "lmanganello136486@direct.tgh.org",
            "affiliation": "N",
            "address_1": "2 Tampa General Cir",
            "city": "Tampa",
            "state": "FL",
            "country_code": "US",
            "postal_code": "336063571",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Tampa, FL

Sources for this page

Verify at the official NPI Registry.