Provider Demographics
NPI:1447849468
Name:MATTHEWS, DOUGLAS MICHAEL (RN 9342045)
Entity type:Individual
Prefix:
First Name:DOUGLAS
Middle Name:MICHAEL
Last Name:MATTHEWS
Suffix:
Gender:M
Credentials:RN 9342045
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:45258 MATTHEWS PL
Mailing Address - Street 2:
Mailing Address - City:CALLAHAN
Mailing Address - State:FL
Mailing Address - Zip Code:32011-3466
Mailing Address - Country:US
Mailing Address - Phone:904-923-3483
Mailing Address - Fax:
Practice Address - Street 1:45258 MATTHEWS PL
Practice Address - Street 2:
Practice Address - City:CALLAHAN
Practice Address - State:FL
Practice Address - Zip Code:32011-3466
Practice Address - Country:US
Practice Address - Phone:904-923-3483
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-14
Last Update Date:2021-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9232045163WE0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WE0003XNursing Service ProvidersRegistered NurseEmergency