Provider Demographics
NPI:1588688915
Name:MARTIN, PATRICIA (ARNP)
Entity type:Individual
Prefix:
First Name:PATRICIA
Middle Name:
Last Name:MARTIN
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11286 NW 69TH PL
Mailing Address - Street 2:
Mailing Address - City:PARKLAND
Mailing Address - State:FL
Mailing Address - Zip Code:33076-3844
Mailing Address - Country:US
Mailing Address - Phone:954-328-6535
Mailing Address - Fax:954-344-7188
Practice Address - Street 1:951 NORTHWEST 13H ST
Practice Address - Street 2:SUITE 3-D
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33486
Practice Address - Country:US
Practice Address - Phone:561-392-0310
Practice Address - Fax:561-368-0911
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-27
Last Update Date:2008-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP 813282363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLN219688OtherWELLCARE
FLP00362660OtherRAILROAD MEDICARE
FLP00362660OtherRAILROAD MEDICARE