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General NPI Number Information
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NPI Number | 1780960989
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Entity Type | Individual
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Provider Name | MATTILIE GEDNAS ARNP
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Gender | Female
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Dates
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Enumeration Date | 11/01/2011
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Last Update Date | 04/05/2022
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Provider Practice Location Address
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Address Line | 13535 NEMOURS PKWY
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City | ORLANDO
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State | FL
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Zip | 32827-7402
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Country | US
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Telephone | 407-273-4132
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 191
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City | ROCKLAND
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State | DE
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Zip | 19732-0191
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Country | US
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Telephone | 302-651-5985
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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 | 363LP0200X
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Taxonomy Name | Pediatric Nurse Practitioner
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License Number | 9223587
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | APRN9223587
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License Number State | FL
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