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NPI Code Detail

MEDICARE: JESSICA MATOS PMHNP

MEDICARE: JESSICA MATOS PMHNP
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 Practitioner39772TN
2363LP0808XPsychiatric/Mental Health Nurse PractitionerAPRN11006062FL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1APRN11006062OTHERFLFL DOH

General Provider Information

NPI Number : 1306479399
Entity Type Code : Individual
Provider Name (Legal Business Name) : JESSICA MATOS PMHNP
Provider Business Mailing Address
First Line : PO BOX 1137
Second Line :
City : MELBOURNE
State : FL
Zip : 32902-1137
Country : US
Telephone Number : 321-952-9696
Fax Number : 321-952-7937
Provider Business Practice Location Address
First Line : 2120 SARNO RD
Second Line :
City : MELBOURNE
State : FL
Zip : 32935-3084
Country : US
Telephone Number : 321-241-6800
Fax Number : 321-241-6890
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/18/2020
Last Update Date : 02/02/2026

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