Provider Demographics
NPI:1902195951
Name:DEMATTEO, JOANNE (CRNFA)
Entity Type:Individual
Prefix:
First Name:JOANNE
Middle Name:
Last Name:DEMATTEO
Suffix:
Gender:F
Credentials:CRNFA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12880 COMMODITY PL
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33626-3101
Mailing Address - Country:US
Mailing Address - Phone:813-343-5500
Mailing Address - Fax:866-462-7445
Practice Address - Street 1:12880 COMMODITY PL
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33626-3101
Practice Address - Country:US
Practice Address - Phone:813-343-5500
Practice Address - Fax:866-462-7445
Is Sole Proprietor?:No
Enumeration Date:2011-03-30
Last Update Date:2015-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NR14998400163WR0006X
PARN553033163WR0006X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WR0006XNursing Service ProvidersRegistered NurseRegistered Nurse First Assistant