Provider Demographics
NPI:1801531165
Name:GIL, MATTHEW C (APRN)
Entity type:Individual
Prefix:MR
First Name:MATTHEW
Middle Name:C
Last Name:GIL
Suffix:
Gender:M
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3730 MIDTOWN DR APT 1340
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33607-4819
Mailing Address - Country:US
Mailing Address - Phone:732-492-4859
Mailing Address - Fax:
Practice Address - Street 1:14446 N DALE MABRY HWY
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33618-2020
Practice Address - Country:US
Practice Address - Phone:732-492-4859
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-02
Last Update Date:2024-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11017690363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner