Provider Demographics
NPI:1104152677
Name:MATHEWS, SOCORRO MIRYAM (ARNP)
Entity type:Individual
Prefix:MS
First Name:SOCORRO
Middle Name:MIRYAM
Last Name:MATHEWS
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6100 SW 183RD WAY
Mailing Address - Street 2:
Mailing Address - City:SOUTHWEST RANCHES
Mailing Address - State:FL
Mailing Address - Zip Code:33331-1640
Mailing Address - Country:US
Mailing Address - Phone:954-806-9697
Mailing Address - Fax:
Practice Address - Street 1:7150 W 20TH AVE STE 109
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33016-5509
Practice Address - Country:US
Practice Address - Phone:305-827-8399
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-19
Last Update Date:2009-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL2626162363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner