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Provider Information for 1033767587

Please Note: Issuance of an NPI does not ensure or validate that the Health Care Provider is Licensed or Credentialed. For more information please refer to NPI: What You Need to Know

KRISTEN LEE MATULIS DNP, CNP

Gender: FEMALE

Individual NPI: 1033767587

Calendar   Last Updated:  2020-12-14
  Certification Date:  2020-12-14

Details

Name Value
NPI 1033767587
Enumeration Date 2019-08-28
NPI Type 1 - Individual
Sole Proprietor NO
Status Active
Mailing Address 10150 HIGHLAND MANOR DR STE 240
TAMPA, FL 33610-9750
United States

Phone: 813-259-1013 | Fax: 813-254-0396
View Map External Link
Primary Practice Address 10150 HIGHLAND MANOR DR STE 240
TAMPA, FL 33610-9750
United States

Phone: 813-259-1013 | Fax:
View Map External Link
Health Information Exchange
Endpoint Type Endpoint Endpoint Description Use Content Type Affiliation Endpoint Location
Other Identifiers
Issuer State Number
MEDICAID FL 104216100
Taxonomy
Primary Taxonomy Selected Taxonomy State License Number
Yes 363LG0600X - Nurse Practitioner Gerontology FL 11003829