Provider Demographics
NPI:1215563564
Name:ANDERSON, MATTHEW VERN (APRN)
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:VERN
Last Name:ANDERSON
Suffix:
Gender:M
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2837 RIVER RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32825-8744
Mailing Address - Country:US
Mailing Address - Phone:706-331-6406
Mailing Address - Fax:
Practice Address - Street 1:436 AIRPORT RD STE 20
Practice Address - Street 2:
Practice Address - City:ARDEN
Practice Address - State:NC
Practice Address - Zip Code:28704-8403
Practice Address - Country:US
Practice Address - Phone:407-200-2352
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-03-19
Last Update Date:2023-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5015734207Q00000X, 363LF0000X
FL11006161363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine