Provider Demographics
NPI:1154704567
Name:ESPINOSA, MATTHEW (FNP)
Entity type:Individual
Prefix:
First Name:MATTHEW
Middle Name:
Last Name:ESPINOSA
Suffix:
Gender:M
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:102 WOODMONT BLVD STE 600
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37205-5250
Mailing Address - Country:US
Mailing Address - Phone:615-314-5257
Mailing Address - Fax:
Practice Address - Street 1:1501 W SUNSET RD
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89014-6636
Practice Address - Country:US
Practice Address - Phone:725-269-7001
Practice Address - Fax:725-269-7003
Is Sole Proprietor?:No
Enumeration Date:2015-07-02
Last Update Date:2023-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVAPRN002323363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NVAPRN002323OtherSTATE LICENSE
NV1154704567Medicaid