Healthcare Provider Details

I. General information

NPI: 1477005122
Provider Name (Legal Business Name): COURTNEY RACQUEL MATHIS MSN, ARNP, WHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/28/2016
Last Update Date: 09/02/2026
Certification Date: 09/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2000 FOWLER GROVE BLVD # 3
WINTER GARDEN FL
34787-5050
US

IV. Provider business mailing address

2000 FOWLER GROVE BLVD # 3
WINTER GARDEN FL
34787
US

V. Phone/Fax

Practice location:
  • Phone: 407-303-1380
  • Fax: 407-303-1385
Mailing address:
  • Phone: 407-303-1380
  • Fax: 407-303-1385

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LX0001X
TaxonomyObstetrics & Gynecology Nurse Practitioner
License Number903706
License Number StateMS
# 2
Primary TaxonomyN
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License Number903706
License Number StateMS
# 3
Primary TaxonomyY
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License NumberAPRN9434446
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: