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NPI Code Detail

MEDICARE: MR. MARC ANDREW MATTISON P.A.

MEDICARE: MR. MARC ANDREW MATTISON P.A.
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
1363AM0700XMedical Physician AssistantPA9102918FL

Other Identifiers

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

General Provider Information

NPI Number : 1780761825
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. MARC ANDREW MATTISON P.A.
Provider Business Mailing Address
First Line : 6101 BLUE LAGOON DR STE 200
Second Line :
City : MIAMI
State : FL
Zip : 33126-3168
Country : US
Telephone Number :
Fax Number : 813-876-4997
Provider Business Practice Location Address
First Line : 228 W ALEXANDER ST
Second Line :
City : PLANT CITY
State : FL
Zip : 33563-7157
Country : US
Telephone Number : 813-754-5480
Fax Number : 877-285-9902
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/01/2006
Last Update Date : 03/25/2026

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