Individual provider Active NPI

Anabel Maria Morales Mangual, MD

  • Family Medicine Physician
  • Lakeland, FL
National Provider Identifier
1245615004
Registry record updated Oct 6, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
ME147414 Issued in FL
Practice address
4715 S Florida Ave Ste 200
Lakeland, FL 33813-2101
Phone
(863) 209-7004
Fax
(863) 274-3542
NPI assigned
Jul 22, 2015
Last updated
Oct 6, 2020By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Oct 6, 2020

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X ME147414 FL Primary

Addresses

Primary practice location

4715 S Florida Ave Ste 200
Lakeland, FL 33813-2101

Mailing address

4715 S Florida Ave Ste 200
Lakeland, FL 33813-2101
Phone (863) 209-7004

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: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20201008002306 FL Practitioner - Family Practice 3375874050 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
ME147414FLMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Dedicated Senior Medical Center of Florida, LLC CurrentSince Oct 1, 2020 Accepting new patients
Dedicated Senior Medical Center of Florida, LLC CurrentSince Oct 1, 2020 Accepting new patients

Locations

4715 S Florida Ave
Lakeland, FL 33813
Phone (863) 209-7003

4715 S Florida Ave
Ste 200
Lakeland, FL 33813
Phone (863) 209-7004

1395 NW 167th St
Miami Gardens, FL 33169
Phone (305) 831-4760

Interoperability endpoints

  • Direct secure messaging: anabel.morales.mangual.1@33201.direct.athenahealth.com

Organizations & group practices 2

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

NPI Registry JSON

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

{
    "created_epoch": "1437523200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1601942400000",
    "number": "1245615004",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4715 S FLORIDA AVE STE 200",
            "city": "LAKELAND",
            "state": "FL",
            "postal_code": "338132101",
            "telephone_number": "863-209-7004",
            "fax_number": "863-274-3542"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4715 S FLORIDA AVE STE 200",
            "city": "LAKELAND",
            "state": "FL",
            "postal_code": "338132101",
            "telephone_number": "863-209-7004",
            "fax_number": "863-274-3542"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MORALES MANGUAL",
        "first_name": "ANABEL",
        "middle_name": "MARIA",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2015-07-22",
        "last_updated": "2020-10-06",
        "certification_date": "2020-10-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "FL",
            "license": "ME147414",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Lakeland, FL

Sources for this page

Verify at the official NPI Registry.