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NPI Code Detail

MEDICARE: HEIDI MATTISON

MEDICARE: HEIDI MATTISON
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363LP0808XPsychiatric/Mental Health Nurse PractitionerAPRN9315459FL
2363LF0000XFamily Nurse PractitionerAPRN9315459FL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1043667520
Entity Type Code : Individual
Provider Name (Legal Business Name) : HEIDI MATTISON
Provider Business Mailing Address
First Line : 501 N REO ST
Second Line :
City : TAMPA
State : FL
Zip : 33609-1012
Country : US
Telephone Number : 813-549-2134
Fax Number : 813-864-4436
Provider Business Practice Location Address
First Line : 4730 N HABANA AVE STE 104
Second Line :
City : TAMPA
State : FL
Zip : 33614-7165
Country : US
Telephone Number : 813-549-2134
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/16/2016
Last Update Date : 01/27/2026

Similar Medicare Providers

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Practice Location Address:
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Practice Fax:
1104092972 — DR. NEIL JAMES ELLIS M.D.
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33614-7165
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Practice Fax:
1619368313 — DR. ELAINE RIEFKOHL ORTIZ MD
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Directions to “ HEIDI MATTISON ” Practice Location

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