MEDICARE: DA'TWAN LAURICE MATHIS APRN

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	363LF0000X	Family Nurse Practitioner	APRN11020672	FL
2	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	APRN11020672	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1346973187
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DA'TWAN LAURICE MATHIS APRN

Provider Business Mailing Address
First Line	:	517 BUENA VISTA ST
Second Line	:
City	:	LAKELAND
State	:	FL
Zip	:	33805-4504
Country	:	US
Telephone Number	:	863-688-3674
Fax Number	:

Provider Business Practice Location Address
First Line	:	517 BUENA VISTA ST
Second Line	:
City	:	LAKELAND
State	:	FL
Zip	:	33805-4504
Country	:	US
Telephone Number	:	863-688-3674
Fax Number	:

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

Provider Enumeration Date	:	07/08/2022
Last Update Date	:	03/29/2024

Similar Medicare Providers

1295680312 — CLEARPATH WELLNESS CARE LLC
Practice Location Address:

517 BUENA VISTA ST
LAKELAND, FL
33805-4504

Practice Phone: 315-547-0502
Practice Fax:

1417942681 — GREGORY L NEDURIAN M.D.
Practice Location Address:

521 BUENA VISTA ST
LAKELAND, FL
33805-4504

Practice Phone: 863-687-0550
Practice Fax: 863-682-7700

1265566012 — GREGORY L. NEDURIAN, M.D., P.A.
Practice Location Address:

521 BUENA VISTA ST
LAKELAND, FL
33805-4504

Practice Phone: 863-687-0550
Practice Fax: 863-682-7700

1912607334 — MRS. SARA BUNLOETH SAY SMITH ARNP
Practice Location Address:

517 BUENA VISTA ST
LAKELAND, FL
33805-4504

Practice Phone: 863-648-4275
Practice Fax:

1073218574 — DANIELLE MARAGIS
Practice Location Address:

517 BUENA VISTA ST
LAKELAND, FL
33805-4504

Practice Phone: 863-688-3674
Practice Fax:

1871467977 — SHARELL ALLEN
Practice Location Address:

517 BUENA VISTA ST
LAKELAND, FL
33805-4504

Practice Phone: 863-688-3674
Practice Fax:

Directions to “ DA'TWAN LAURICE MATHIS APRN” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.