Healthcare Provider Details

I. General information

NPI: 1386496446
Provider Name (Legal Business Name): ALAYAH THRESA MATAMOROS APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/03/2024
Last Update Date: 06/15/2026
Certification Date: 06/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 SW ARCHER RD
GAINESVILLE FL
32610-6261
US

IV. Provider business mailing address

9147 SW 197TH CIR
DUNNELLON FL
34432-2685
US

V. Phone/Fax

Practice location:
  • Phone: 352-273-5422
  • Fax:
Mailing address:
  • Phone: 405-822-1814
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAPRN11032084
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number11032084
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAPRN11032084
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: