Provider Demographics
NPI:1104841469
Name:MATTHEWS, BEATRICE M (ARNP)
Entity Type:Individual
Prefix:
First Name:BEATRICE
Middle Name:M
Last Name:MATTHEWS
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 1:2308 NORTHERN LEAF ST
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32817-3424
Mailing Address - Country:US
Mailing Address - Phone:407-398-9971
Mailing Address - Fax:
Practice Address - Street 1:9009 CORPORATE LAKE DR
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33634-2367
Practice Address - Country:US
Practice Address - Phone:407-398-9971
Practice Address - Fax:855-312-3644
Is Sole Proprietor?:No
Enumeration Date:2006-07-13
Last Update Date:2018-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP2919842363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLU6571ZMedicare ID - Type Unspecified
FLQ58444Medicare UPIN