Doctor Name: | JEENA MATHEW |
NPI Number: | 1043670771 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | |
License Number: | ARNP 9173328 |
Business Practice Address: | 1170 Nevermore Cir Bartow, FL - 338307404 |
Business Phone Number: | 8635121055 |
Business Fax Number: | |
Mailing Address: | 1170 Nevermore Cir, BARTOW |
State: | FL |
Postal Code: | 338307404 |
Phone Number: | 8635121055 |
Fax Number: | |
NPI Enumeration Date: | 02/23/2016 |
NPI Last Update Date: | 02/23/2016 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363LF0000X |
License Number: | ARNP 9173328 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | FL |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Nurse Practitioner |
Taxonomy Specialization: | Family |
Taxonomy Definition: |