Healthcare Provider Details

I. General information

NPI: 1417322488
Provider Name (Legal Business Name): VIVIANE MARIA MATARAZZO MATCHETT ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/02/2015
Last Update Date: 12/02/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

307 E NEW HAVEN AVE
MELBOURNE FL
32901-4576
US

IV. Provider business mailing address

485 TRINIDAD DR
SATELLITE BEACH FL
32937-3444
US

V. Phone/Fax

Practice location:
  • Phone: 321-729-8223
  • Fax:
Mailing address:
  • Phone: 813-765-1138
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberARNP9270144
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: