Provider Demographics
NPI:1285804039
Name:SUZANNE MARTINCAK , PL
Entity type:Organization
Organization Name:SUZANNE MARTINCAK , PL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NURSE PRACTIONER/ MIDWIFE
Authorized Official - Prefix:MRS
Authorized Official - First Name:SUZANNE
Authorized Official - Middle Name:
Authorized Official - Last Name:MARTINCAK
Authorized Official - Suffix:
Authorized Official - Credentials:ARNP
Authorized Official - Phone:850-628-1969
Mailing Address - Street 1:521 HIGHWAY 2297
Mailing Address - Street 2:
Mailing Address - City:PANAMA CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32404-2919
Mailing Address - Country:US
Mailing Address - Phone:850-628-1969
Mailing Address - Fax:
Practice Address - Street 1:924 W 13TH ST
Practice Address - Street 2:
Practice Address - City:PANAMA CITY
Practice Address - State:FL
Practice Address - Zip Code:32401-2214
Practice Address - Country:US
Practice Address - Phone:850-763-8643
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-07
Last Update Date:2008-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9176243363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty