Provider Demographics
NPI:1700514577
Name:MATUS, MATTHEW ALEXANDER (SRNA)
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:ALEXANDER
Last Name:MATUS
Suffix:
Gender:M
Credentials:SRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:285 UPTOWN BLVD APT 655
Mailing Address - Street 2:
Mailing Address - City:ALTAMONTE SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:32701-4009
Mailing Address - Country:US
Mailing Address - Phone:386-216-9685
Mailing Address - Fax:
Practice Address - Street 1:ORLANDO REGIONAL MEDICAL CENTER
Practice Address - Street 2:52 W UNDERWOOD ST
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:38206
Practice Address - Country:US
Practice Address - Phone:321-841-5111
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-10
Last Update Date:2024-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11032799363L00000X
FL9423147163WC1600X
FL149264367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163WC1600XNursing Service ProvidersRegistered NurseContinuing Education/Staff Development