Provider Demographics
NPI:1861920373
Name:MATSON, NIKOLA KANKOVA (CRNA)
Entity type:Individual
Prefix:DR
First Name:NIKOLA
Middle Name:KANKOVA
Last Name:MATSON
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:810 LAS CRUCES CT
Mailing Address - Street 2:
Mailing Address - City:LADY LAKE
Mailing Address - State:FL
Mailing Address - Zip Code:32159-5777
Mailing Address - Country:US
Mailing Address - Phone:772-559-7849
Mailing Address - Fax:
Practice Address - Street 1:201 W GUAVA ST
Practice Address - Street 2:
Practice Address - City:LADY LAKE
Practice Address - State:FL
Practice Address - Zip Code:32159-1701
Practice Address - Country:US
Practice Address - Phone:772-532-8559
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-05-28
Last Update Date:2025-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VACRNA0024187386367500000X
MACRNA10025152367500000X
KSCRNA43558330032367500000X
MOCRNA2023013699367500000X
TXCRNA1171167367500000X
FLCRNA3353032367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO910123006Medicaid