Provider Demographics
NPI:1093202889
Name:MATUS, JESSIE CONSUELO (ARNP)
Entity Type:Individual
Prefix:
First Name:JESSIE
Middle Name:CONSUELO
Last Name:MATUS
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 1:9500 S DADELAND BLVD STE 200
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33156-2866
Mailing Address - Country:US
Mailing Address - Phone:786-530-3820
Mailing Address - Fax:305-675-3378
Practice Address - Street 1:9408 SW 87TH AVE STE 200
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33176-2416
Practice Address - Country:US
Practice Address - Phone:305-913-0666
Practice Address - Fax:305-913-0663
Is Sole Proprietor?:No
Enumeration Date:2018-04-17
Last Update Date:2024-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9347318363LF0000X, 363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLARNP9347318OtherARNP LICENSE