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General NPI Number Information
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NPI Number | 1750860367
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Entity Type | Individual
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Provider Name | CHRISTAL LOUISE DA MATA FNP, PMHNP
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Gender | Female
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Dates
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Enumeration Date | 08/14/2018
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Last Update Date | 04/30/2025
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Provider Practice Location Address
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Address Line | 21301 POWERLINE RD STE 103
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City | BOCA RATON
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State | FL
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Zip | 33433-2389
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Country | US
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Telephone | 561-235-5205
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Fax |
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Provider Business Mailing Address
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Address Line | 397 SW BELMONT CIR
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City | PORT ST LUCIE
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State | FL
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Zip | 34953-7103
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Country | US
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Telephone | 279-718-8835
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Fax | 772-673-8440
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 4704263161
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 4704263161
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License Number State | MI
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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 | APRN11016039
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License Number State | FL
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Taxonomy #4
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | APRN11016039
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License Number State | FL
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