Provider Demographics
NPI:1831664044
Name:MATIAS, JANE MARIE (FNP)
Entity Type:Individual
Prefix:
First Name:JANE
Middle Name:MARIE
Last Name:MATIAS
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:MISS
Other - First Name:JANE
Other - Middle Name:MARIE
Other - Last Name:CARVAJAL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3347 W 18TH LANE
Mailing Address - Street 2:
Mailing Address - City:YUMA
Mailing Address - State:AZ
Mailing Address - Zip Code:85364
Mailing Address - Country:US
Mailing Address - Phone:928-550-1412
Mailing Address - Fax:
Practice Address - Street 1:11142 S SCOTTSDALE DR
Practice Address - Street 2:
Practice Address - City:YUMA
Practice Address - State:AZ
Practice Address - Zip Code:85367-5616
Practice Address - Country:US
Practice Address - Phone:928-305-6211
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-04
Last Update Date:2018-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAP11662363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care