Provider Demographics
NPI:1891265930
Name:MATAMANA, BRINDA (MSN, FNP-C, APRN)
Entity Type:Individual
Prefix:
First Name:BRINDA
Middle Name:
Last Name:MATAMANA
Suffix:
Gender:F
Credentials:MSN, FNP-C, APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1464 WILLIAM WAY
Mailing Address - Street 2:
Mailing Address - City:FARMERS BRANCH
Mailing Address - State:TX
Mailing Address - Zip Code:75234-1332
Mailing Address - Country:US
Mailing Address - Phone:832-814-6488
Mailing Address - Fax:
Practice Address - Street 1:12606 GREENVILLE AVE STE 185
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75243-1921
Practice Address - Country:US
Practice Address - Phone:469-547-6541
Practice Address - Fax:469-547-6545
Is Sole Proprietor?:No
Enumeration Date:2018-12-02
Last Update Date:2023-11-07
Deactivation Date:2023-09-20
Deactivation Code:
Reactivation Date:2023-10-06
Provider Licenses
StateLicense IDTaxonomies
TXAP139045363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner