Provider Demographics
NPI:1871335299
Name:MATAR, CAROLINE ISABELLA
Entity type:Individual
Prefix:
First Name:CAROLINE
Middle Name:ISABELLA
Last Name:MATAR
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:155 TOWN VILLAGE BLVD APT 7303
Mailing Address - Street 2:
Mailing Address - City:MEXICO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32456-7217
Mailing Address - Country:US
Mailing Address - Phone:682-209-4560
Mailing Address - Fax:
Practice Address - Street 1:401 N ALF COLEMAN RD
Practice Address - Street 2:
Practice Address - City:PANAMA CITY BEACH
Practice Address - State:FL
Practice Address - Zip Code:32407-2567
Practice Address - Country:US
Practice Address - Phone:850-749-5020
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-07
Last Update Date:2024-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSZ11984235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist