Vera Renita Mathis

Primary specialty

Adult Care Home FacilityTaxonomy code 311ZA0620X

License

6906328 Issued in FL

Practice address

331 Thomasdale Ave
Haines City, FL 33844-6381

Phone

(863) 242-1261

NPI assigned

Sep 6, 2013

Last updated

Sep 6, 2013By the provider in NPPES

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1378425600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1378425600000",
    "number": "1568897700",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "331 THOMASDALE AVE",
            "city": "HAINES CITY",
            "state": "FL",
            "postal_code": "338446381",
            "telephone_number": "863-242-1261"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "331 THOMASDALE AVE",
            "city": "HAINES CITY",
            "state": "FL",
            "postal_code": "338446381",
            "telephone_number": "863-242-1261"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MATHIS",
        "first_name": "VERA",
        "middle_name": "RENITA",
        "name_prefix": "Mrs.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2013-09-06",
        "last_updated": "2013-09-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "311ZA0620X",
            "taxonomy_group": "",
            "desc": "Custodial Care Facility, Adult Care Home",
            "state": "FL",
            "license": "6906328",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "002740700",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Makeia Keshon Martin
• Marisa Martin
• Flavia Martinez Acosta
• Clovis Airton Martins Braga Jr.
• Sukumar Mathan, M.D.
• Gabriel A Matos, LMT
• Mitzy Mattei Rivera, APRN
• Maya Diagnostic Imaging, LLC
• Marilyn Maya
• John McCants

• Adult Care Home Facility in Haines City, FL
• Providers in Haines City, FL by specialty
• Adult Care Home Facility in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 6, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.