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NPI Code Detail

MEDICARE: DANIELLE JO MATTA MSN, RN, AGACNP-BC

MEDICARE: DANIELLE JO MATTA MSN, RN, AGACNP-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
1363LA2100XAcute Care Nurse Practitioner1073627TX
2208M00000XHospitalist Physician1073627TX
3363L00000XNurse Practitioner31925SC
4363LA2200XAdult Health Nurse Practitioner1073627TX

General Provider Information

NPI Number : 1790256329
Entity Type Code : Individual
Provider Name (Legal Business Name) : DANIELLE JO MATTA MSN, RN, AGACNP-BC
Provider Business Mailing Address
First Line : PO BOX 23321
Second Line :
City : NEW YORK
State : NY
Zip : 10087-4321
Country : US
Telephone Number : 803-286-1214
Fax Number :
Provider Business Practice Location Address
First Line : 800 W MEETING ST
Second Line :
City : LANCASTER
State : SC
Zip : 29720-2202
Country : US
Telephone Number : 803-286-1214
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/07/2018
Last Update Date : 05/15/2026

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