Provider Demographics
NPI:1386177053
Name:WIMBERLY, MAR'TINA (MD)
Entity type:Individual
Prefix:
First Name:MAR'TINA
Middle Name:
Last Name:WIMBERLY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:MAR'TINA
Other - Middle Name:
Other - Last Name:REYNOLDS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 100383
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32610-0383
Mailing Address - Country:US
Mailing Address - Phone:352-392-4541
Mailing Address - Fax:352-294-8519
Practice Address - Street 1:1600 SW ARCHER RD
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32610-3742
Practice Address - Country:US
Practice Address - Phone:352-265-8670
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-04-09
Last Update Date:2020-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
FL145002207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program