Individual
MR. MATTHEW W PRITIKIN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PMHNP-BC
Contact information
Practice address
2550 SE WALTON RD, PORT ST LUCIE, FL 34952-7168
(772) 335-0400
Mailing address
789 SW TULIP BLVD, PORT SAINT LUCIE, FL 34953-3306
(954) 701-0478
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
9372893
FL
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
11037179
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
11037179
FLORIDA BOARD OF NURSING/ APRN
FL
01
—
9372893
FLORIDA BOARD OF HEALTH/NURSING
FL
Enumeration date
03/31/2020
Last updated
02/17/2025
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