Provider Demographics
NPI:1801641469
Name:LEBRON, MATTHEW THOMAS (APRN)
Entity type:Individual
Prefix:
First Name:MATTHEW
Middle Name:THOMAS
Last Name:LEBRON
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 1:2060 SHERWOOD FOREST DR
Mailing Address - Street 2:
Mailing Address - City:ORANGE CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32763-6355
Mailing Address - Country:US
Mailing Address - Phone:407-453-3506
Mailing Address - Fax:
Practice Address - Street 1:2060 SHERWOOD FOREST DR
Practice Address - Street 2:
Practice Address - City:ORANGE CITY
Practice Address - State:FL
Practice Address - Zip Code:32763-6355
Practice Address - Country:US
Practice Address - Phone:407-212-7424
Practice Address - Fax:386-310-0586
Is Sole Proprietor?:No
Enumeration Date:2024-04-18
Last Update Date:2025-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11032005363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health