MEDICARE: MS. LIBBY ANN MATHIS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	374U00000X	Home Health Aide		FL
2	251E00000X	Home Health Agency

General Provider Information

NPI Number	:	1013711449
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. LIBBY ANN MATHIS

Provider Business Mailing Address
First Line	:	249 SW KIMBALL CIR
Second Line	:
City	:	PORT SAINT LUCIE
State	:	FL
Zip	:	34953-6216
Country	:	US
Telephone Number	:	772-878-6673
Fax Number	:	772-878-6673

Provider Business Practice Location Address
First Line	:	249 SW KIMBALL CIR
Second Line	:
City	:	PORT SAINT LUCIE
State	:	FL
Zip	:	34953-6216
Country	:	US
Telephone Number	:	772-878-6673
Fax Number	:	772-878-6673

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/03/2025
Last Update Date	:	04/03/2025

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