Provider Demographics
NPI:1629345194
Name:MATTIS, PAULETTE E (FNP-BC)
Entity Type:Individual
Prefix:
First Name:PAULETTE
Middle Name:E
Last Name:MATTIS
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:PAULETTE
Other - Middle Name:E
Other - Last Name:MATTIS-HENRY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:ARNP
Mailing Address - Street 1:450 GIBNER RD
Mailing Address - Street 2:
Mailing Address - City:CARLISLE
Mailing Address - State:PA
Mailing Address - Zip Code:17013-5090
Mailing Address - Country:US
Mailing Address - Phone:717-245-3117
Mailing Address - Fax:717-245-3499
Practice Address - Street 1:1505 DELAWARE AVE
Practice Address - Street 2:
Practice Address - City:FORT PIERCE
Practice Address - State:FL
Practice Address - Zip Code:34950-3975
Practice Address - Country:US
Practice Address - Phone:772-461-1402
Practice Address - Fax:561-847-2306
Is Sole Proprietor?:No
Enumeration Date:2011-11-28
Last Update Date:2024-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP2688882363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily