Provider Demographics
NPI:1912903576
Name:MATHEWS, CECILIA (ARNP)
Entity Type:Individual
Prefix:
First Name:CECILIA
Middle Name:
Last Name:MATHEWS
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:525 E 15TH ST
Mailing Address - Street 2:
Mailing Address - City:PANAMA CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32405-5412
Mailing Address - Country:US
Mailing Address - Phone:850-522-4485
Mailing Address - Fax:850-914-6281
Practice Address - Street 1:2944 PENNSYLVANIA AVE STE L
Practice Address - Street 2:
Practice Address - City:MARIANNA
Practice Address - State:FL
Practice Address - Zip Code:32448-2741
Practice Address - Country:US
Practice Address - Phone:850-526-5500
Practice Address - Fax:850-526-5536
Is Sole Proprietor?:No
Enumeration Date:2005-06-28
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP1615692163WP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL766462100Medicaid
S69891Medicare UPIN
Y7048DMedicare UPIN
Y7048CMedicare ID - Type Unspecified
Y7048EMedicare ID - Type Unspecified
Y7048AMedicare ID - Type Unspecified
FL766462100Medicaid