Provider Demographics
NPI:1548285802
Name:PRANGE, MARK ERWIN (PHD)
Entity type:Individual
Prefix:DR
First Name:MARK
Middle Name:ERWIN
Last Name:PRANGE
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:13907 N DALE MABRY HWY
Mailing Address - Street 2:SUITE 204
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33618-2411
Mailing Address - Country:US
Mailing Address - Phone:813-961-7727
Mailing Address - Fax:813-961-0354
Practice Address - Street 1:13907 N DALE MABRY HWY
Practice Address - Street 2:SUITE 204
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33618-2411
Practice Address - Country:US
Practice Address - Phone:813-961-7727
Practice Address - Fax:813-961-0354
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY4250103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical