Doctor Name: | MRS. ANISA LEE MATHIS |
NPI Number: | 1285640813 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | PA-C |
License Number: | PA9102039 |
Business Practice Address: | 113 Lielmanis Ave Hurlburt Field, FL - 325445613 |
Business Phone Number: | 8508812337 |
Business Fax Number: | 8508812323 |
Mailing Address: | 113 Lielmanis Ave, HURLBURT FIELD |
State: | FL |
Postal Code: | 325445613 |
Phone Number: | 8508812337 |
Fax Number: | 8508812323 |
NPI Enumeration Date: | 08/01/2006 |
NPI Last Update Date: | 07/08/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363AM0700X |
License Number: | PA9102039 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | FL |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Physician Assistant |
Taxonomy Specialization: | Medical |
Taxonomy Definition: |