Provider Demographics
NPI:1063762318
Name:CROSS, MARTHA MELO (RN)
Entity type:Individual
Prefix:MS
First Name:MARTHA
Middle Name:MELO
Last Name:CROSS
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9395 SW 130TH ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33176-5763
Mailing Address - Country:US
Mailing Address - Phone:305-338-6781
Mailing Address - Fax:305-232-2396
Practice Address - Street 1:9395 SW 130TH ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33176-5763
Practice Address - Country:US
Practice Address - Phone:305-338-6781
Practice Address - Fax:305-232-2396
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-13
Last Update Date:2012-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1951992163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health