Provider Demographics
NPI:1881714863
Name:GEORGE, MATTHEW STEPHEN (ARNP - BC)
Entity type:Individual
Prefix:MR
First Name:MATTHEW
Middle Name:STEPHEN
Last Name:GEORGE
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Gender:M
Credentials:ARNP - BC
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Mailing Address - Street 1:9838 OLD BAYMEADOWS RD
Mailing Address - Street 2:# 388
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32256-8101
Mailing Address - Country:US
Mailing Address - Phone:904-332-7431
Mailing Address - Fax:904-332-7408
Practice Address - Street 1:9471 BAYMEADOWS RD STE 303
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32256-7936
Practice Address - Country:US
Practice Address - Phone:904-332-7431
Practice Address - Fax:904-332-7408
Is Sole Proprietor?:No
Enumeration Date:2007-03-31
Last Update Date:2021-11-15
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLARNP 9213136363LA2200X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLAF390ZOtherMEDICARE PTAN