MEDICARE: RICIA J MATHEW ARNP

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
1	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	ARNP 3343182	FL

Other Identifiers

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

General Provider Information

NPI Number	:	1093049736
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RICIA J MATHEW ARNP

Provider Business Mailing Address
First Line	:	1202 GOLF MEADOW BLVD
Second Line	:
City	:	VALRICO
State	:	FL
Zip	:	33596-7297
Country	:	US
Telephone Number	:	813-643-6595
Fax Number	:

Provider Business Practice Location Address
First Line	:	1201 ORIENT RD
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33619-3325
Country	:	US
Telephone Number	:	813-247-8972
Fax Number	:	813-247-8975

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/29/2009
Last Update Date	:	09/29/2009

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