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NPI Code Detail

MEDICARE: ANNA TATIRA MATARUKA FNP

MEDICARE: ANNA TATIRA MATARUKA FNP
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
1363LF0000XFamily Nurse Practitioner5014395NC
2363LF0000XFamily Nurse Practitioner20481SC

General Provider Information

NPI Number : 1497204119
Entity Type Code : Individual
Provider Name (Legal Business Name) : ANNA TATIRA MATARUKA FNP
Provider Business Mailing Address
First Line : 1147 EBENEZER RD
Second Line :
City : ROCK HILL
State : SC
Zip : 29732-2355
Country : US
Telephone Number : 803-329-6648
Fax Number : 803-985-4134
Provider Business Practice Location Address
First Line : 1147 EBENEZER RD
Second Line :
City : ROCK HILL
State : SC
Zip : 29732-2355
Country : US
Telephone Number : 803-329-6648
Fax Number : 803-985-4134
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/22/2016
Last Update Date : 02/05/2024

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