Provider Demographics
NPI:1699177717
Name:WOLLAND, MATTHEW JAY (NP-C)
Entity Type:Individual
Prefix:MR
First Name:MATTHEW
Middle Name:JAY
Last Name:WOLLAND
Suffix:
Gender:M
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1440 NW 110TH AVE.
Mailing Address - Street 2:APT. #399
Mailing Address - City:PLANTATION
Mailing Address - State:FL
Mailing Address - Zip Code:33322-6945
Mailing Address - Country:US
Mailing Address - Phone:813-841-7058
Mailing Address - Fax:
Practice Address - Street 1:1440 NW 110TH AVE.
Practice Address - Street 2:APT. #399
Practice Address - City:PLANTATION
Practice Address - State:FL
Practice Address - Zip Code:33322-6945
Practice Address - Country:US
Practice Address - Phone:813-841-7058
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-19
Last Update Date:2014-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9293830363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily