Healthcare Provider Details

I. General information

NPI: 1275466187
Provider Name (Legal Business Name): PRISCILLA MARIE MATOS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/08/2026
Last Update Date: 06/08/2026
Certification Date: 06/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2451 SW 118TH CT
MIAMI FL
33175-2435
US

IV. Provider business mailing address

2451 SW 118TH CT
MIAMI FL
33175-2435
US

V. Phone/Fax

Practice location:
  • Phone: 786-516-5842
  • Fax:
Mailing address:
  • Phone: 786-516-5842
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License NumberAPRN11043915
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: