Healthcare Provider Details

I. General information

NPI: 1609503275
Provider Name (Legal Business Name): MATTHEW IRA LOCKHART APRN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/04/2022
Last Update Date: 08/28/2023
Certification Date: 08/28/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8130 LAKEWOOD MAIN ST STE 3
LAKEWOOD RANCH FL
34202-5068
US

IV. Provider business mailing address

PO BOX 947407
ATLANTA GA
30394-7407
US

V. Phone/Fax

Practice location:
  • Phone: 941-499-2700
  • Fax:
Mailing address:
  • Phone: 941-917-2600
  • Fax: 941-917-7884

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License NumberAPRN11020346
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN11020346
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: