Alisha Dawn Mattern, FNP-C
Individual provider Active NPI Family Nurse Practitioner · Immokalee, FL
NPI 1528719085 · NPPES record last updated Jul 17, 2023
Key facts
- NPI
- 1528719085
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Family Nurse Practitioner 363LF0000X
- License
- APRN11025669 (FL)
- Practice address
- 1120 S 1St St
Immokalee, FL 34142-4303 - Phone
- (239) 867-3400
- NPI assigned
- Jan 15, 2022
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 3
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in MO, TX
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20230519000946 | MO | Practitioner - Nurse Practitioner | 3779949607 | Reassigns benefits to 1 organization |
| I20250220002542 | TX | Practitioner - Nurse Practitioner | 3779949607 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Nurse Practitioner
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| APRN11025669 | FL | MD | Family Nurse Practitioner |
| 2022001544 | MO | MD | Family Nurse Practitioner |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Seminole Tribe of Florida Health Dept. | Current | Accepting new patients | |
| Mercy East Ambulatory Services LLC | Current |
Accepting new patients | |
| Seminole Tribe of Florida | Current |
Accepting new patients |
Locations
111 W Coral Way
Hollywood, FL 33021
Phone (954) 962-2009
1120 S 1st St
Immokalee, FL 34142
Phone (239) 867-3400
409 Lafayette Ctr
Manchester, MO 63011
Phone (636) 707-0764
2991 Highway K
O Fallon, MO 63368
Phone (636) 435-2333
901 Patients First Dr
Ste 1200
Washington, MO 63090
Phone (636) 390-1777
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Nurse Practitioner | 363LF0000X | 2022001544 | MO | |
| Family Nurse Practitioner | 363LF0000X | APRN11025669 | FL | Yes |
Addresses
Primary practice location
1120 S 1St St
Immokalee, FL 34142-4303
Mailing address
1120 S 1St St
Immokalee, FL 34142-4303
Phone (239) 867-3400
Other providers in Immokalee, FL
- Diana Concepcion Lopez-Perez
- Emlyn Louis
- Michael Luvera
- Elizabeth Irene Maldonado
- Julie Alexandra Mancera Loftin
- Giuliana Farias McQuirt
- Angelique Melendez-Blanch
- Jean Kesnold Mesidor
- Sandra Juanita Milan
- Laverne Beal Miller
All providers in Immokalee, FL · Family Nurse Practitioner in Florida
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 17, 2023. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.