Provider Demographics
NPI:1124038013
Name:MATTHEWS-FERRARI, KATINA A (MD)
Entity type:Individual
Prefix:DR
First Name:KATINA
Middle Name:A
Last Name:MATTHEWS-FERRARI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19022 MIDWAY BLVD
Mailing Address - Street 2:
Mailing Address - City:PORT CHARLOTTE
Mailing Address - State:FL
Mailing Address - Zip Code:33948-9648
Mailing Address - Country:US
Mailing Address - Phone:941-639-8300
Mailing Address - Fax:941-639-6831
Practice Address - Street 1:1700 EDUCATION AVE
Practice Address - Street 2:
Practice Address - City:PUNTA GORDA
Practice Address - State:FL
Practice Address - Zip Code:33950-6222
Practice Address - Country:US
Practice Address - Phone:941-639-8300
Practice Address - Fax:941-639-6831
Is Sole Proprietor?:No
Enumeration Date:2006-08-09
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME529332084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL143636000OtherMAGELLAN
FL1529693OtherUBH
08319OtherBLUE CROSS
FL5551041OtherAETNA
FL043040401Medicaid
FL97564OtherMHNET
FLN302999OtherSTAYWELL
08319OtherBLUE CROSS