Provider Demographics
NPI:1285492280
Name:IKE, MATILDA CHIMEZIE (DR (DNP))
Entity type:Individual
Prefix:
First Name:MATILDA
Middle Name:CHIMEZIE
Last Name:IKE
Suffix:
Gender:F
Credentials:DR (DNP)
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:501 SE NOME DR
Mailing Address - Street 2:
Mailing Address - City:PORT ST LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34984-8945
Mailing Address - Country:US
Mailing Address - Phone:754-215-1202
Mailing Address - Fax:
Practice Address - Street 1:501 SE NOME DR
Practice Address - Street 2:
Practice Address - City:PORT ST LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34984-8945
Practice Address - Country:US
Practice Address - Phone:754-215-1202
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-13
Last Update Date:2024-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL239833251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health