Provider Demographics
NPI:1679030639
Name:MATOS, JOANNA (APRN)
Entity Type:Individual
Prefix:
First Name:JOANNA
Middle Name:
Last Name:MATOS
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4 MARY ELLEN LN
Mailing Address - Street 2:
Mailing Address - City:SICKLERVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:08081-9744
Mailing Address - Country:US
Mailing Address - Phone:610-203-2033
Mailing Address - Fax:
Practice Address - Street 1:4 MARY ELLEN LN
Practice Address - Street 2:
Practice Address - City:SICKLERVILLE
Practice Address - State:NJ
Practice Address - Zip Code:08081-9744
Practice Address - Country:US
Practice Address - Phone:610-203-2033
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-02-26
Last Update Date:2019-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ00900100363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care