Provider Demographics
NPI:1316739758
Name:MATEO, REYNA MARLENE (AGPCNP-BC)
Entity type:Individual
Prefix:
First Name:REYNA
Middle Name:MARLENE
Last Name:MATEO
Suffix:
Gender:F
Credentials:AGPCNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1270 COOK RD
Mailing Address - Street 2:
Mailing Address - City:IRON CITY
Mailing Address - State:TN
Mailing Address - Zip Code:38463-4625
Mailing Address - Country:US
Mailing Address - Phone:931-724-4590
Mailing Address - Fax:
Practice Address - Street 1:1270 COOK RD
Practice Address - Street 2:
Practice Address - City:IRON CITY
Practice Address - State:TN
Practice Address - Zip Code:38463-4625
Practice Address - Country:US
Practice Address - Phone:931-724-4590
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-05-21
Last Update Date:2025-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN29507363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care