Provider Demographics
NPI:1154400315
Name:STRICKLAND, MATYA AMMA COOKSEY (FNP)
Entity type:Individual
Prefix:
First Name:MATYA
Middle Name:AMMA COOKSEY
Last Name:STRICKLAND
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:MATYA
Other - Middle Name:AMMA
Other - Last Name:COOKSEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:823 GATEWAY CENTER WAY
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92102-4541
Mailing Address - Country:US
Mailing Address - Phone:619-515-2300
Mailing Address - Fax:619-906-4564
Practice Address - Street 1:2391 ISLAND AVE
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92102-2941
Practice Address - Country:US
Practice Address - Phone:619-515-2435
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-06
Last Update Date:2023-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA19549363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW5352OtherUPIN
CA19549OtherLIC