Healthcare Provider Details

I. General information

NPI: 1487080271
Provider Name (Legal Business Name): FLORIYA TKACHUK-MATTIOLI APN-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/24/2013
Last Update Date: 07/13/2026
Certification Date: 07/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

218A SUNSET RD STE 100
WILLINGBORO NJ
08046-1110
US

IV. Provider business mailing address

301 LIPPINCOTT DR STE 410
MARLTON NJ
08053-4197
US

V. Phone/Fax

Practice location:
  • Phone: 856-291-8920
  • Fax: 856-291-8922
Mailing address:
  • Phone: 856-355-0340
  • Fax: 856-355-0330

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number26NJ00466500
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: