Provider Demographics
NPI:1851044390
Name:MATTHEWS, DOMINIC (REGISTERED NURSE)
Entity type:Individual
Prefix:MRS
First Name:DOMINIC
Middle Name:
Last Name:MATTHEWS
Suffix:
Gender:F
Credentials:REGISTERED NURSE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:278 LASALLE LEFALL DR
Mailing Address - Street 2:
Mailing Address - City:QUINCY
Mailing Address - State:FL
Mailing Address - Zip Code:32351-5324
Mailing Address - Country:US
Mailing Address - Phone:850-519-4569
Mailing Address - Fax:850-743-6034
Practice Address - Street 1:278 LASALLE LEFALL DR
Practice Address - Street 2:
Practice Address - City:QUINCY
Practice Address - State:FL
Practice Address - Zip Code:32351-5324
Practice Address - Country:US
Practice Address - Phone:850-519-4569
Practice Address - Fax:850-743-6034
Is Sole Proprietor?:No
Enumeration Date:2022-02-03
Last Update Date:2022-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRN9399546163W00000X, 163WC1500X, 163WA2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WA2000XNursing Service ProvidersRegistered NurseAdministrator
No163W00000XNursing Service ProvidersRegistered Nurse
No163WC1500XNursing Service ProvidersRegistered NurseCommunity Health