MR. EDGAR IVAN MATAMOROS (NPI# 1801308317) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1801308317 |
| Entity Type | Individual |
| Full Name | MR. EDGAR IVAN MATAMOROS |
| Credential | PMHNP-BC |
| Practice Address |
3800 W Broward Blvd # 100 Fort Lauderdale FL 33312-1018 |
| Practice Telephone | 9545871008 |
| Mailing Telephone | 9545871008 |
| Enumeration Date | 2017-10-25 |
| Last Update Date | 2019-06-21 |
| Gender Code | M |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363LP0808X |
Nurse Practitioner Specialization: Psych/Mental Health |
ARNP9397926 | FL | Physician Assistants & Advanced Practice Nursing Providers |
| Street Address |
3800 W BROWARD BLVD # 100 |
| City | FORT LAUDERDALE |
| State | FL |
| Zip Code | 33312-1018 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1316558984 | Lauren Thomas | Social Worker | 3800 W Broward Blvd # 100, Fort Lauderdale, FL 33312-1018 | 2020-08-16 |
| 1215443361 | Mala Tanya-sue Williams-lawrence | Social Worker | 3800 W Broward Blvd # 100, Fort Lauderdale, FL 33312-1018 | 2017-12-26 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1679112965 | Krista Moreno | Marriage & Family Therapist | 2699 Stirling Road Building C Suite 403e, Fort Lauderdale, FL 33312 | 2020-01-03 |
| 1700428026 | Caring Village of Lauderdale LLC | Assisted Living Facility | 408-412 Sw 7th Ave, Fort Lauderdale, FL 33312 | 2019-10-09 |
| 1548742356 | Inspire Acupuncture | Acupuncturist | 1000 Riverside Drive, Fort Lauderdale, FL 33312 | 2018-08-29 |
| 1447762919 | Daniel Desta Bekele | General Practice | 1001 W Las Olas Blvd Apt 4, Fort Lauderdale, FL 33312 | 2017-10-24 |
| 1649798653 | Angel Luis Perez | Nurse Practitioner | 3041 Sw 47 Street, Fort Lauderdale, FL 33312 | 2017-08-30 |
| 1902322738 | Ashley Ingrid Rini | Dentist | 1620 Sw 33rd Ave, Fort Lauderdale, FL 33312 | 2017-08-14 |
| 1548794993 | Elise Cruz | Nurse Practitioner | 3301 Sw 16th Street, Fort Lauderdale, FL 33312 | 2017-04-12 |
| 1619415924 | Antoinette Battle | Nurse Practitioner | 3470 Sw 19th Street, Fort Lauderdale, FL 33312 | 2017-02-07 |
| 1902344252 | Melissa Miller | Counselor | 2962 Southwest 26th Terrace, 204, Fort Lauderale, FL 33312 | 2017-02-07 |
| 1164975934 | Brandon Nieves Stella | Technician, Other | 620 Sw 14th Ter, Fort Lauderdale, FL 33312 | 2016-07-28 |
| Find all providers in zip 33312 | ||||
| Taxonomy Code | 363LP0808X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Nurse Practitioner |
| Specialization | Psych/Mental Health |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1922615608 | Urszula Dorfman | Nurse Practitioner | 1 Las Olas Cir Apt 609, Fort Lauderdale, FL 33316-1634 | 2020-09-28 |
| 1750915005 | Fernande Joseph | Nurse Practitioner | 6051 Sw 195th Ave, Fort Lauderdale, FL 33332-3399 | 2020-02-26 |
| 1629266796 | S T E P H Inc | Nurse Practitioner | 609 Sw 19th St, Fort Lauderdale, FL 33315-2049 | 2007-10-14 |
| 1487154746 | Michelle Rose-marie Desarmes | Nurse Practitioner | 2900 W Prospect Rd, Fort Lauderdale, FL 33309-2519 | 2018-02-13 |
| 1629583406 | Jean C Marchand | Nurse Practitioner | 330 Sw 27th Ave, Fort Lauderdale, FL 33312-2051 | 2017-12-03 |
| 1962939496 | Sherna Constant | Nurse Practitioner | 4200 Sw 54th Ct, Fort Lauderdale, FL 33314-6726 | 2017-05-15 |
| 1386196368 | Carlton Mills | Nurse Practitioner | 1600 S Andrews Ave, West Wing 4 South, Fort Lauderdale, FL 33316-2510 | 2016-10-26 |
| 1245685031 | Nkechi Jebose-chinye | Nurse Practitioner | 330 Sw 27th Ave, Fort Lauderdale, FL 33312-2051 | 2016-04-28 |
| 1942668777 | Josie Fusco | Nurse Practitioner | 2340 Ne 53rd St, Fort Lauderdale, FL 33308-3212 | 2016-02-08 |
| 1861867228 | Christian Dieunez Oscar Jean Baptiste | Nurse Practitioner | 6401 N Federal Hwy, Fort Lauderdale, FL 33308-1427 | 2015-12-09 |
| Find all providers in FORT LAUDERDALE | ||||
| City | FORT LAUDERDALE |
| Zip Code | 33312 |
Please comment or provide details below to improve the information on MR. EDGAR IVAN MATAMOROS.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.