Healthcare Provider Details

I. General information

NPI: 1831664044
Provider Name (Legal Business Name): JANE MARIE MATIAS FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MISS JANE MARIE CARVAJAL

II. Dates (important events)

Enumeration Date: 10/04/2018
Last Update Date: 01/02/2025
Certification Date: 01/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11142 S SCOTTSDALE DR
YUMA AZ
85367-5616
US

IV. Provider business mailing address

2400 S AVENUE A
YUMA AZ
85364-7170
US

V. Phone/Fax

Practice location:
  • Phone: 928-305-6211
  • Fax:
Mailing address:
  • Phone: 928-344-2000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License NumberAP11662
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: