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NPI Code Detail

MEDICARE: MR. THEODORE FRANK MATEJKA ARNP-BC

MEDICARE: MR. THEODORE FRANK MATEJKA ARNP-BC
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
1363LA2200XAdult Health Nurse PractitionerARNP3074712FL
2363LP0808XPsychiatric/Mental Health Nurse PractitionerARNP3074712FL

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 : 1396742490
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. THEODORE FRANK MATEJKA ARNP-BC
Provider Business Mailing Address
First Line : 1150 RED JOHN DR
Second Line :
City : DAYTONA BEACH
State : FL
Zip : 32124-1016
Country : US
Telephone Number : 386-236-1711
Fax Number : 386-226-0200
Provider Business Practice Location Address
First Line : 1150 RED JOHN DR
Second Line :
City : DAYTONA BEACH
State : FL
Zip : 32124-1016
Country : US
Telephone Number : 386-236-1711
Fax Number : 386-226-0200
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/05/2005
Last Update Date : 03/26/2013

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