Provider Demographics
NPI:1528460714
Name:PASTORA, MARTHA NINOSKA (NP)
Entity type:Individual
Prefix:
First Name:MARTHA
Middle Name:NINOSKA
Last Name:PASTORA
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:MARTHA
Other - Middle Name:NINOSKA
Other - Last Name:PASTORA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:NP
Mailing Address - Street 1:216 SE CORRECTIONS WAY
Mailing Address - Street 2:
Mailing Address - City:LAKE CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32025-2013
Mailing Address - Country:US
Mailing Address - Phone:386-292-7212
Mailing Address - Fax:
Practice Address - Street 1:216 SE CORRECTIONS WAY
Practice Address - Street 2:
Practice Address - City:LAKE CITY
Practice Address - State:FL
Practice Address - Zip Code:32025
Practice Address - Country:US
Practice Address - Phone:386-292-7212
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-19
Last Update Date:2014-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL2726022363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily