Healthcare Provider Details

I. General information

NPI: 1346610813
Provider Name (Legal Business Name): MARY LOUISE MATTAS ARNP-C, CRNFA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/28/2015
Last Update Date: 08/23/2024
Certification Date: 08/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1832 17TH AVE N
LAKE WORTH FL
33460-6432
US

IV. Provider business mailing address

1832 17TH AVE N
LAKE WORTH FL
33460-6432
US

V. Phone/Fax

Practice location:
  • Phone: 561-727-9260
  • Fax:
Mailing address:
  • Phone: 561-727-9260
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WR0006X
TaxonomyRegistered Nurse First Assistant
License NumberARNP9175209
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN9175209
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: