Healthcare Provider Details

I. General information

NPI: 1295291227
Provider Name (Legal Business Name): JESSICA ROSE MATTHEWS ARPN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/14/2019
Last Update Date: 03/03/2025
Certification Date: 03/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2357 PINELAND LN
CLEARWATER FL
33763-4533
US

IV. Provider business mailing address

455 PINELLAS ST STE 400
CLEARWATER FL
33756-3356
US

V. Phone/Fax

Practice location:
  • Phone: 407-267-8505
  • Fax:
Mailing address:
  • Phone: 727-445-1991
  • Fax: 727-445-1986

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WC0200X
TaxonomyCritical Care Medicine Registered Nurse
License NumberRN9363288
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number11036107
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: