Healthcare Provider Details

I. General information

NPI: 1881714863
Provider Name (Legal Business Name): MATTHEW STEPHEN GEORGE ARNP - BC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/31/2007
Last Update Date: 11/15/2021
Certification Date: 11/15/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9471 BAYMEADOWS RD STE 303
JACKSONVILLE FL
32256-7936
US

IV. Provider business mailing address

9838 OLD BAYMEADOWS RD # 388
JACKSONVILLE FL
32256-8101
US

V. Phone/Fax

Practice location:
  • Phone: 904-332-7431
  • Fax: 904-332-7408
Mailing address:
  • Phone: 904-332-7431
  • Fax: 904-332-7408

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberARNP 9213136
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberARNP 9213136
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: