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General NPI Number Information
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NPI Number | 1215313671
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Entity Type | Individual
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Provider Name | EMILY MATTEI GODFREY PA-C
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Gender | Female
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Dates
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Enumeration Date | 08/07/2015
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Last Update Date | 02/18/2019
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Provider Practice Location Address
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Address Line | 501 6TH AVE S
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City | ST PETERSBURG
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State | FL
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Zip | 33701-4634
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Country | US
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Telephone | 727-767-4343
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Fax |
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Provider Business Mailing Address
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Address Line | 501 6TH AVE S STE 702A
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City | ST PETERSBURG
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State | FL
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Zip | 33701-4634
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Country | US
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Telephone | 727-767-4343
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Fax | 727-767-4331
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | PA9111269
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License Number State | FL
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