Individual
CHRISTAL LOUISE DA MATA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP, PMHNP
Contact information
Practice address
21301 POWERLINE RD STE 103, BOCA RATON, FL 33433-2389
(561) 235-5205
Mailing address
397 SW BELMONT CIR, PORT ST LUCIE, FL 34953-7103
(279) 718-8835
(772) 673-8440
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
4704263161
MI
363LF0000X
Family Nurse Practitioner
APRN11016039
FL
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
4704263161
MI
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
APRN11016039
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0000000000
NONE
—
Enumeration date
08/14/2018
Last updated
04/30/2025
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