Provider Demographics
NPI:1013711449
Name:MATHIS, LIBBY ANN
Entity type:Individual
Prefix:MS
First Name:LIBBY
Middle Name:ANN
Last Name:MATHIS
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:249 SW KIMBALL CIR
Mailing Address - Street 2:
Mailing Address - City:PORT SAINT LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34953-6216
Mailing Address - Country:US
Mailing Address - Phone:772-878-6673
Mailing Address - Fax:772-878-6673
Practice Address - Street 1:249 SW KIMBALL CIR
Practice Address - Street 2:
Practice Address - City:PORT SAINT LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34953-6216
Practice Address - Country:US
Practice Address - Phone:772-878-6673
Practice Address - Fax:772-878-6673
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-03
Last Update Date:2025-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL374U00000X
251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No374U00000XNursing Service Related ProvidersHome Health Aide