PENN L MATTOX PA-C
NPI 1104805001
Physician Assistant - Surgical in Orlando, FL

Active since January 10, 2006
4215 EDGEWATER DR, ORLANDO, FL 32804(407) 539-2000(407) 398-0050 Get Directions Write a Review

NPPES record last updated: March 17, 2018. Verified against the NPPES registry weekly; last sync: August 02, 2026.

Record update history: Mar 17, 2018, Dec 14, 2017 (2 updates tracked since 2017).

About Penn L Mattox Pa-c NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

PENN L MATTOX PA-C (NPI 1104805001) is an individual surgical provider in Orlando, Florida, licensed in Florida (PA380) and active in the NPI registry since January 2006. She maintains a secondary practice location in Saint Petersburg.

NPPES Registry Identity

NPI1104805001
Entity TypeIndividualFemale
Primary Taxonomy363AS0400X
Provider Legal NamePENN L MATTOXCredential: PA-C
Location Address4215 EDGEWATER DROrlando, FL 32804-2206
Mailing Address1955 1st Avenue North, Suite 101Saint Petersburg, FL 33713-8907 · (727) 822-3500 · Fax (727) 822-3228
Fax(407) 398-0050
Sole ProprietorNo
Enumeration DateJanuary 10, 2006
Last NPPES UpdateMarch 17, 20182 updates tracked since enumeration
NPI 1104805001 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 2

Primary SpecialtyPhysician Assistant · SurgicalPhysician Assistants & Advanced Practice Nursing Providers
Taxonomy Code363AS0400X
License Licensed in FL · PA380
Also ListedPhysician AssistantTaxonomy 363A00000X · License PA3280 (FL)
4215 EDGEWATER DR, Orlando, FL 32804

Secondary Practice Location 1

Location 11955 1st Avenue North, Suite 101Saint Petersburg, FL 33713-8907 · Phone (727) 822-3500 · Fax (727) 822-3228

Other Identifiers 2

Medicaid2920905 00FL
OtherE4034YFL · Fl Mcare - Qss Southeast Clinical Services

Other Providers at the Same Location NPPES 12

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

Physician Assistant (Surgical)
4215 EDGEWATER DR
ORLANDO, FL 32804
Nurse Practitioner (Adult Health)
4215 EDGEWATER DR
ORLANDO, FL 32804
Physician Assistant
4215 EDGEWATER DR
ORLANDO, FL 32804
Physician Assistant (Surgical)
4215 EDGEWATER DR
ORLANDO, FL 32804
Physician Assistant
4215 EDGEWATER DR
ORLANDO, FL 32804
Physician Assistant (Surgical)
4215 EDGEWATER DR
ORLANDO, FL 32804
Physician Assistant (Surgical)
4215 EDGEWATER DR
ORLANDO, FL 32804
Physician Assistant (Surgical)
4215 EDGEWATER DR
ORLANDO, FL 32804

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Penn Mattox's NPI number?

The NPI number for Penn Mattox is 1104805001. It was assigned to this individual provider in the NPPES registry on January 10, 2006.

Where is Penn Mattox located?

Penn Mattox practices at 4215 Edgewater Dr, Orlando, FL 32804. The listed phone number is (407) 539-2000.

What is Penn Mattox's specialty?

The primary specialty registered for this NPI is Physician Assistant, specializing in Surgical, with taxonomy code 363AS0400X.

When was this NPI record last updated?

The NPPES record for Penn Mattox was last updated on March 17, 2018. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 8 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.