Healthcare Provider Details

I. General information

NPI: 1679092134
Provider Name (Legal Business Name): MATTHEW EASHOO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/15/2017
Last Update Date: 09/15/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1700 S 23RD ST
FORT PIERCE FL
34950-4803
US

IV. Provider business mailing address

3100 W END AVE STE 800
NASHVILLE TN
37203-1378
US

V. Phone/Fax

Practice location:
  • Phone: 772-461-4000
  • Fax: 888-468-6511
Mailing address:
  • Phone: 615-345-5400
  • Fax: 888-468-6511

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code242T00000X
TaxonomyPerfusionist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: