Healthcare Provider Details

I. General information

NPI: 1073175345
Provider Name (Legal Business Name): REJOY MATHAI APRN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/08/2019
Last Update Date: 03/21/2025
Certification Date: 03/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1625 SE 3RD AVE STE 600
FORT LAUDERDALE FL
33316-2521
US

IV. Provider business mailing address

1608 SE 3RD AVE FL 3
FORT LAUDERDALE FL
33316-2564
US

V. Phone/Fax

Practice location:
  • Phone: 954-355-4106
  • Fax: 954-888-3669
Mailing address:
  • Phone: 954-355-4106
  • Fax: 954-888-3669

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN11003012
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: