Individual
KELLY ANN MATTHEUS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1050 OLD CAMP RD STE 270, THE VILLAGES, FL 32162-1762
(352) 633-1966
Mailing address
1050 OLD CAMP RD STE 270, THE VILLAGES, FL 32162-1762
(352) 633-1966
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
RN9382006
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
RN9382006
STATE LICENSE
FL
Enumeration date
08/19/2020
Last updated
08/19/2020
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