Healthcare Provider Details

I. General information

NPI: 1356953905
Provider Name (Legal Business Name): MAYELIN MATOS ARPN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/17/2020
Last Update Date: 06/18/2026
Certification Date: 06/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8320 W POCAHONTAS AVE
TAMPA FL
33615-2821
US

IV. Provider business mailing address

8320 W POCAHONTAS AVE
TAMPA FL
33615-2821
US

V. Phone/Fax

Practice location:
  • Phone: 813-709-7442
  • Fax: 813-725-9637
Mailing address:
  • Phone: 786-316-7192
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN11008662
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAPRN11008662
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: