| Organization Name: | MATHIS DREAM LLC |
| NPI Number: | 1164649703 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | DEBRA LYNN MATHIS (OWNER- NURSE PRACTITIONER) |
| Mailing Address: | 1321 Georgia Ave Baker |
| State: | FL US |
| Postal Code: | 325312605 |
| Phone Number: | 8505372700 |
| Fax Number: | 8505372702 |
| NPI Enumeration Date: | 04/18/2007 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LF0000X |
| License Number: | ARNP 1427202 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | FL |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Family |
| Taxonomy Definition: | |