Provider Demographics
NPI:1841629912
Name:MILLS, MATTHEW (PA)
Entity type:Individual
Prefix:MR
First Name:MATTHEW
Middle Name:
Last Name:MILLS
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7544 JACQUE RD
Mailing Address - Street 2:
Mailing Address - City:HUDSON
Mailing Address - State:FL
Mailing Address - Zip Code:34667-7162
Mailing Address - Country:US
Mailing Address - Phone:727-697-2200
Mailing Address - Fax:727-857-4352
Practice Address - Street 1:7544 JACQUE RD
Practice Address - Street 2:
Practice Address - City:HUDSON
Practice Address - State:FL
Practice Address - Zip Code:34667-7162
Practice Address - Country:US
Practice Address - Phone:727-697-2200
Practice Address - Fax:727-857-4352
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-08
Last Update Date:2013-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9107481363A00000X, 363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant