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General NPI Number Information
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NPI Number | 1215563564
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Entity Type | Individual
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Provider Name | MATTHEW VERN ANDERSON APRN
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Gender | Male
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Dates
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Enumeration Date | 03/19/2020
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Last Update Date | 02/20/2023
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Provider Practice Location Address
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Address Line | 436 AIRPORT RD STE 20
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City | ARDEN
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State | NC
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Zip | 28704-8403
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Country | US
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Telephone | 407-200-2352
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Fax |
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Provider Business Mailing Address
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Address Line | 2837 RIVER RIDGE DR
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City | ORLANDO
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State | FL
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Zip | 32825-8744
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Country | US
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Telephone | 706-331-6406
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Fax |
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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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 5015734
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License Number State | NC
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 11006161
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License Number State | FL
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Taxonomy #3
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 5015734
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License Number State | NC
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