Provider Demographics
NPI:1467000240
Name:MATTHEWS, IAN MAXWELL (APRN)
Entity Type:Individual
Prefix:MR
First Name:IAN
Middle Name:MAXWELL
Last Name:MATTHEWS
Suffix:
Gender:M
Credentials:APRN
Other - Prefix:MR
Other - First Name:IAN
Other - Middle Name:MAXWELL
Other - Last Name:HERSHKOWITZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:382 NE 191ST ST, PMB 848652
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33179
Mailing Address - Country:US
Mailing Address - Phone:706-421-3400
Mailing Address - Fax:786-808-1726
Practice Address - Street 1:13160 MINDANAO WAY STE 213
Practice Address - Street 2:
Practice Address - City:MARINA DEL REY
Practice Address - State:CA
Practice Address - Zip Code:90292-6358
Practice Address - Country:US
Practice Address - Phone:925-282-1778
Practice Address - Fax:415-296-5299
Is Sole Proprietor?:No
Enumeration Date:2019-08-26
Last Update Date:2023-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY889538163W00000X
MARN2383657163W00000X, 363LP0808X
FLRN9636729163W00000X
CA95171771163W00000X
MDAC006045363LP0808X
NY405126363LP0808X
CANP95014083363LP0808X
FLAPRN11027493363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse