Healthcare Provider Details

I. General information

NPI: 1295291227
Provider Name (Legal Business Name): JESSICA ROSE MATTHEWS ARPN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/14/2019
Last Update Date: 09/08/2026
Certification Date: 09/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6919 N DALE MABRY HWY STE 125
TAMPA FL
33614-3972
US

IV. Provider business mailing address

6919 N DALE MABRY HWY STE 125
TAMPA FL
33614
US

V. Phone/Fax

Practice location:
  • Phone: 813-497-9661
  • Fax: 813-615-8468
Mailing address:
  • Phone: 813-497-9661
  • Fax: 813-615-8468

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WC0200X
TaxonomyCritical Care Medicine Registered Nurse
License NumberRN9363288
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number11036107
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: