Individual
DA'TWAN LAURICE MATHIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
APRN
Contact information
Practice address
517 BUENA VISTA ST, LAKELAND, FL 33805-4504
(863) 688-3674
Mailing address
517 BUENA VISTA ST, LAKELAND, FL 33805-4504
(863) 688-3674
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
APRN11020672
FL
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
APRN11020672
FL
Other
Enumeration date
07/08/2022
Last updated
03/29/2024
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