Provider Demographics
NPI:1235688441
Name:MATA, ORLAND (MSN, ARNP-BC)
Entity Type:Individual
Prefix:
First Name:ORLAND
Middle Name:
Last Name:MATA
Suffix:
Gender:M
Credentials:MSN, ARNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4525 COD AVE
Mailing Address - Street 2:
Mailing Address - City:SEBRING
Mailing Address - State:FL
Mailing Address - Zip Code:33870-8422
Mailing Address - Country:US
Mailing Address - Phone:787-909-5731
Mailing Address - Fax:
Practice Address - Street 1:130 MEDICAL CENTER AVE
Practice Address - Street 2:
Practice Address - City:SEBRING
Practice Address - State:FL
Practice Address - Zip Code:33870-5463
Practice Address - Country:US
Practice Address - Phone:863-840-0639
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-28
Last Update Date:2021-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9422001363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily