Healthcare Provider Details

I. General information

NPI: 1255133096
Provider Name (Legal Business Name): KATIA MATTEUCCI MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/25/2025
Last Update Date: 05/22/2025
Certification Date: 05/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1329 SW 16TH ST
GAINESVILLE FL
32608-1128
US

IV. Provider business mailing address

1329 SW 16TH STREET
GAINESVILLE FL
32610-0175
US

V. Phone/Fax

Practice location:
  • Phone: 352-265-5911
  • Fax:
Mailing address:
  • Phone: 352-265-5911
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number42533
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: