Individual
ELIZABETH A MATTESI
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
1223 GATEWAY DR, MELBOURNE, FL 32901
(321) 728-6002
(321) 676-9731
Mailing address
3300 S FISKE BLVD, ROCKLEDGE, FL 32955-4306
(321) 728-6002
(321) 676-9731
Taxonomy
Speciality
Code
Description
License number
State
363AS0400X
Surgical Physician Assistant
Primary
PA3294
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
019045900
—
FL
01
—
E3398Y
MEDICARE
FL
01
—
P01165532
FL RR MEDICARE
—
Enumeration date
05/10/2006
Last updated
03/09/2020
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