Provider Demographics
NPI:1023388865
Name:MATZEN, BREANA MARIE (CNM, ARNP)
Entity Type:Individual
Prefix:
First Name:BREANA
Middle Name:MARIE
Last Name:MATZEN
Suffix:
Gender:F
Credentials:CNM, ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1658 ST VINCENTS WAY
Mailing Address - Street 2:SUITE 130
Mailing Address - City:MIDDLEBURG
Mailing Address - State:FL
Mailing Address - Zip Code:32068-8446
Mailing Address - Country:US
Mailing Address - Phone:904-264-1628
Mailing Address - Fax:904-264-8386
Practice Address - Street 1:1658 ST VINCENTS WAY
Practice Address - Street 2:SUITE 130
Practice Address - City:MIDDLEBURG
Practice Address - State:FL
Practice Address - Zip Code:32068-8446
Practice Address - Country:US
Practice Address - Phone:904-264-1628
Practice Address - Fax:904-264-8386
Is Sole Proprietor?:No
Enumeration Date:2012-01-11
Last Update Date:2016-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9287898363L00000X, 367A00000X, 363LX0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LX0001XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLY09YPOtherBLUE CROSS BLUE SHIELD
FL004589600Medicaid