Charlie Mata, CRNA
Nurse Anesthetist, Certified Registered in Fort Lauderdale, FL. Individual provider (NPI-1).
NPI number1013663343
StatusActive
Last updated in NPPESFeb 21, 2025
Details
- NPI
- 1013663343
- Entity type
- Individual (NPI-1)
- Name
- Charlie Mata
- Credential
- CRNA
- Sex
- Male
- Sole proprietor
- Yes
- Enumeration date
- Feb 24, 2022
- Certification date
- Feb 24, 2022
- Last updated
- Feb 21, 2025
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 367500000X | Nurse Anesthetist, Certified Registered | APRN11033142 | FL | Yes |
| 163W00000X | Registered Nurse | 9347349 | FL |
Practice location
4725 N. Federal HwyFort Lauderdale, FL 33308-4603
Phone 954-771-8000
Mailing address
2006 Hogback RdSuite 5a
Ann Arbor, MI 48105
Phone 734-263-2414 · Fax 734-773-3471
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