Healthcare Provider Details

I. General information

NPI: 1104841469
Provider Name (Legal Business Name): BEATRICE M MATTHEWS A.R.N.P.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/13/2006
Last Update Date: 12/10/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9009 CORPORATE LAKE DR
TAMPA FL
33634-2367
US

IV. Provider business mailing address

2308 NORTHERN LEAF ST
ORLANDO FL
32817-3424
US

V. Phone/Fax

Practice location:
  • Phone: 407-398-9971
  • Fax: 855-312-3644
Mailing address:
  • Phone: 407-398-9971
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberARNP2919842
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: