Provider Demographics
NPI:1073514402
Name:REYES-MATRANGA, CONSUELO (ARNP)
Entity Type:Individual
Prefix:
First Name:CONSUELO
Middle Name:
Last Name:REYES-MATRANGA
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1217 EWING AVE
Mailing Address - Street 2:
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33756-3407
Mailing Address - Country:US
Mailing Address - Phone:727-446-3021
Mailing Address - Fax:727-446-7423
Practice Address - Street 1:1217 EWING AVE
Practice Address - Street 2:
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33756-3407
Practice Address - Country:US
Practice Address - Phone:727-446-3021
Practice Address - Fax:727-446-7423
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRN1706172363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLP33923Medicare UPIN
FLE5672ZMedicare ID - Type Unspecified