John Michael Blanco Mata, NP

Nurse Practitioner · Prescott, AZ

Individual Active NPI

NPI number 1639871247

Practice location

3250 Gateway Blvd Ste 112
Prescott, AZ 86303-6856
Phone
(708) 248-0049

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NPI record

NPI
1639871247
Entity type
Individual (Type 1)
Enumeration date
March 20, 2023
Last updated
January 31, 2024
Certified
January 31, 2024
Sole proprietor
Yes

Specialties & taxonomy codes

TaxonomyCodeLicenseState
Nurse Practitioner Primary 363L00000X 267971 AZ
Acute Care Nurse Practitioner 363LA2100X 267971 AZ
Adult Health Nurse Practitioner 363LA2200X 267971 AZ
Critical Care Medicine Nurse Practitioner 363LC0200X 267971 AZ
Gerontology Nurse Practitioner 363LG0600X 267971 AZ

Mailing address

PO Box 522
Humboldt, AZ 86329-0522
Phone
(708) 248-0049

About John Michael Mata

John Michael Blanco Mata, NP is a healthcare provider registered in the NPI registry with the primary taxonomy Nurse Practitioner (code 363L00000X). The practice location is 3250 Gateway Blvd Ste 112, Prescott, AZ 86303-6856. The NPI number 1639871247 was assigned on March 20, 2023 and the record was last updated on January 31, 2024.

John Michael Mata lists 5 licenses in the registry: #267971 (AZ) for Nurse Practitioner; #267971 (AZ) for Acute Care Nurse Practitioner; #267971 (AZ) for Adult Health Nurse Practitioner; #267971 (AZ) for Critical Care Medicine Nurse Practitioner; #267971 (AZ) for Gerontology Nurse Practitioner. License numbers are self-reported to NPPES; verify them with the state licensing board.

Frequently asked questions

What is the NPI number of John Michael Blanco Mata, NP?

The NPI number is 1639871247.

What is the phone number of John Michael Mata?

The phone number listed for the practice location is (708) 248-0049.

Where is John Michael Mata located?

3250 Gateway Blvd Ste 112, Prescott, AZ 86303-6856.

What is the taxonomy code for John Michael Mata?

The primary taxonomy code is 363L00000X – Nurse Practitioner; 4 more listed above.

Is this information correct?

All details come from the public NPPES registry. Providers can update their record at nppes.cms.hhs.gov; changes appear here after the next weekly update.

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