Healthcare Provider Details

I. General information

NPI: 1033037692
Provider Name (Legal Business Name): MATTHEW KYLE PURVIS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/09/2026
Last Update Date: 07/09/2026
Certification Date: 07/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

70 W GORE ST STE 101
ORLANDO FL
32806-1124
US

IV. Provider business mailing address

2666 FLICKER CV
SANFORD FL
32773-7070
US

V. Phone/Fax

Practice location:
  • Phone: 321-843-2584
  • Fax:
Mailing address:
  • Phone: 352-408-0535
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number11048968
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: