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General NPI Number Information
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NPI Number | 1861920373
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Entity Type | Individual
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Provider Name | NIKOLA KANKOVA MATSON CRNA
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Gender | Female
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Dates
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Enumeration Date | 05/28/2017
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Last Update Date | 02/25/2026
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Provider Practice Location Address
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Address Line | 201 W GUAVA ST
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City | LADY LAKE
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State | FL
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Zip | 32159-1701
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Country | US
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Telephone | 772-532-8559
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Fax |
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Provider Business Mailing Address
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Address Line | 810 LAS CRUCES CT
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City | LADY LAKE
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State | FL
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Zip | 32159-5777
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Country | US
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Telephone | 772-559-7849
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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 | 367500000X
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Taxonomy Name | Certified Registered Nurse Anesthetist
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License Number | CRNA10025152
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License Number State | MA
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Taxonomy #2
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Taxonomy Code | 367500000X
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Taxonomy Name | Certified Registered Nurse Anesthetist
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License Number | 43-558330
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License Number State | KS
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Taxonomy #3
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Taxonomy Code | 367500000X
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Taxonomy Name | Certified Registered Nurse Anesthetist
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License Number | 2023013699
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License Number State | MO
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Taxonomy #4
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Taxonomy Code | 367500000X
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Taxonomy Name | Certified Registered Nurse Anesthetist
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License Number | CRNA1171167
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License Number State | TX
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Taxonomy #5
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Taxonomy Code | 367500000X
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Taxonomy Name | Certified Registered Nurse Anesthetist
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License Number | CRNA3353032
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License Number State | FL
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Taxonomy #6
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Taxonomy Code | 367500000X
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Taxonomy Name | Certified Registered Nurse Anesthetist
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License Number | CRNA0024187386
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License Number State | VA
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