LISA A. MATTINGLY MD – NPI #1104186907
Family Medicine

Family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity.

LISA MATTINGLY is a physician located in PORT CHARLOTTE, FL. NPPES has assigned the NPI number 1104186907 to LISA MATTINGLY on May 25, 2012. It is a Type-1 NPI, indicating this NPI number is associated with an individual. The primary taxonomy selected by this provider is 207Q00000X from the Health Care Provider Taxonomy code set, which is classified as Family Medicine.

The NPI profile was last updated on May 01, 2026. Use the NPI data found here to bill health insurance companies, identify providers enrolled in Medicare and Medicaid services or other HIPAA compliant transactions. See the complete NPI profile for LISA MATTINGLY below.

NPI Profile for
LISA A. MATTINGLY

NPI Number
1104186907
Enumeration Date

(more than 14 years ago)
Entity Type
Type-1  Individual (Female)
Legal Name
LISA A. MATTINGLY
Credentials
MD
Primary location
1050 LOVELAND BLVD
PORT CHARLOTTE, FL 33980-1813
Phone: (941) 764-0301 Fax:
Mailing address
2710 REW CIR STE 200
OCOEE, FL 34761-2967
Phone: (888) 373-0013 Fax:
Sole Proprietor
No
Updated
Certification Date
May 01, 2026

Note: NPPES allows providers to attest to the accuracy of their NPI data. When a provider request any change to the NPI record, they will be able to attest to their changed NPI data, resulting in an updated certification date.

Identifiers

Identifiers for LISA MATTINGLY

Identifiers are used to associate other provider identifiers such as Medicaid or other insurers (ie:, Blue Cross, Blue Shield, Aetna, Kaiser-Permanente, etc.), with their NPI number. These identifiers can be used in matching an NPI number to an insurer's records. However, not all providers have such numbers and not all providers choose to include them in their NPI information.

DescriptionIssuerStateIdentifier
otherMEDICARE GROUP PTANOK430265YRHZ
medicaidOK200444630A
Taxonomy Code(s)

A taxonomy code is a code that describes the health care service provider's type, classification, and the area of specialization. The primary specialty for this provider is indicated as (Primary) below.

Taxonomy Classification / Specialization State License
207Q00000X
- Family Medicine (Primary)
FL ME146476

The taxonomy codes are selected by the provider at the time of NPI registration. Selection of a taxonomy code does not replace any credentialing or validation process that the provider requesting the code should complete.

Additional Information

Medicare Ordering & Referring
Provider can:
  • Refer to Part B
  • Order Durable Medical Equipment
  • Refer to Home Health Agency
  • Order Power Mobility Devices

Why is my NPI data (personal information) being displayed publicly?
If you have an active NPI profile, your profile is required to be disclosed according to the FOIA and eFOIA. HIPAA also requires covered providers to share their NPI with other providers, health plans, clearinghouses and any entity that may need it for billing purposes.

How do I correct or change the NPI data displayed here?
At any time, providers can make changes to their NPI profile at NPPES. Login to NPPES to make changes online or call (800) 465-3203 for assistance. Changes made at NPPES will be reflected on this web site within a few days.

Can I hide my NPI profile from the public?
Unfortunately, No. The NPPES discloses health care provider data under the Freedom of Information Act to the public, which means anyone may request such information directly from the National Plan & Provider Enumeration System. See the complete CMS Data Dissemination Notice here.