Provider Demographics
NPI:1033445416
Name:MATOS, JOHANNA (PNP)
Entity Type:Individual
Prefix:
First Name:JOHANNA
Middle Name:
Last Name:MATOS
Suffix:
Gender:F
Credentials:PNP
Other - Prefix:
Other - First Name:JOHANNA
Other - Middle Name:
Other - Last Name:GARZA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:7703 FLOYD CURL DR
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78229-3901
Mailing Address - Country:US
Mailing Address - Phone:210-567-9355
Mailing Address - Fax:
Practice Address - Street 1:7703 FLOYD CURL DR
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78229-3901
Practice Address - Country:US
Practice Address - Phone:210-567-9355
Practice Address - Fax:210-567-5903
Is Sole Proprietor?:No
Enumeration Date:2009-10-20
Last Update Date:2017-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN28160775363LP0200X
IN71003123363LP0200X
TX6873536363LP0200X
TXAP121172363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200966730Medicaid
TX327258504OtherCSHCN
TX080462703Medicaid
TX327258503Medicaid
TX327258504OtherCSHCN