Provider Demographics
NPI:1316719685
Name:MATTES, CHRISTINA RUTHANN (APRN)
Entity type:Individual
Prefix:MRS
First Name:CHRISTINA
Middle Name:RUTHANN
Last Name:MATTES
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:MISS
Other - First Name:CHRISTINA
Other - Middle Name:RUTHANN
Other - Last Name:CORRIPIO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 361095
Mailing Address - Street 2:
Mailing Address - City:MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32936-1095
Mailing Address - Country:US
Mailing Address - Phone:321-622-8730
Mailing Address - Fax:
Practice Address - Street 1:1301 W EAU GALLIE BLVD STE 108
Practice Address - Street 2:
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32935-5390
Practice Address - Country:US
Practice Address - Phone:321-622-8730
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-30
Last Update Date:2023-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11029414363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner