Provider Demographics
NPI:1538306311
Name:MATNEY, ANGELICA CRUZ (CRNA)
Entity Type:Individual
Prefix:MISS
First Name:ANGELICA
Middle Name:CRUZ
Last Name:MATNEY
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:MISS
Other - First Name:ANGELICA
Other - Middle Name:ANGELICA
Other - Last Name:CRUZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNA
Mailing Address - Street 1:3100 SPRING FOREST RD STE 130
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27616-2880
Mailing Address - Country:US
Mailing Address - Phone:888-280-9533
Mailing Address - Fax:919-873-9821
Practice Address - Street 1:44045 RIVERSIDE PKWY
Practice Address - Street 2:
Practice Address - City:LEESBURG
Practice Address - State:VA
Practice Address - Zip Code:20176-5101
Practice Address - Country:US
Practice Address - Phone:703-858-6000
Practice Address - Fax:703-776-2623
Is Sole Proprietor?:No
Enumeration Date:2009-01-15
Last Update Date:2014-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CTR53490367500000X
VA0024168417367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD418484000Medicaid
VA1538306311Medicaid
VA1538306311Medicaid
DC166451Y6DMedicare PIN