Provider Demographics
NPI:1235599168
Name:MATA, MIGUEL ANGEL (FNP-C)
Entity Type:Individual
Prefix:
First Name:MIGUEL
Middle Name:ANGEL
Last Name:MATA
Suffix:
Gender:M
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 4199
Mailing Address - Street 2:
Mailing Address - City:MCALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:78502-4199
Mailing Address - Country:US
Mailing Address - Phone:956-322-7662
Mailing Address - Fax:830-632-6568
Practice Address - Street 1:2511 CORNERSTONE BLVD STE 2511
Practice Address - Street 2:
Practice Address - City:EDINBURG
Practice Address - State:TX
Practice Address - Zip Code:78539-8463
Practice Address - Country:US
Practice Address - Phone:956-322-7662
Practice Address - Fax:830-632-6568
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-04
Last Update Date:2022-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP130507363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily