Provider Demographics
NPI:1346394624
Name:MATTSON, DEBORAH DIANE (MS, PA-C)
Entity Type:Individual
Prefix:MS
First Name:DEBORAH
Middle Name:DIANE
Last Name:MATTSON
Suffix:
Gender:F
Credentials:MS, PA-C
Other - Prefix:MS
Other - First Name:DEBORAH
Other - Middle Name:DIANE
Other - Last Name:ADAMCHECK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, PA-C
Mailing Address - Street 1:430 MORTON PLANT ST
Mailing Address - Street 2:STE 405
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33756-3394
Mailing Address - Country:US
Mailing Address - Phone:727-447-0668
Mailing Address - Fax:727-442-9332
Practice Address - Street 1:701 POINSETTIA RD
Practice Address - Street 2:
Practice Address - City:BELLEAIR
Practice Address - State:FL
Practice Address - Zip Code:33756
Practice Address - Country:US
Practice Address - Phone:734-637-9825
Practice Address - Fax:313-375-2305
Is Sole Proprietor?:No
Enumeration Date:2007-01-23
Last Update Date:2016-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9104177363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIP18516Medicare UPIN