Provider Demographics
NPI:1841689007
Name:SLAVEN, MARTHA JILL (APRN-C)
Entity type:Individual
Prefix:
First Name:MARTHA
Middle Name:JILL
Last Name:SLAVEN
Suffix:
Gender:F
Credentials:APRN-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1401 CENTERVILLE RD SUITE 300
Mailing Address - Street 2:
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32308-4675
Mailing Address - Country:US
Mailing Address - Phone:850-878-8121
Mailing Address - Fax:850-942-6515
Practice Address - Street 1:1401 CENTERVILLE RD STE 600
Practice Address - Street 2:
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32308
Practice Address - Country:US
Practice Address - Phone:850-878-8121
Practice Address - Fax:850-942-6515
Is Sole Proprietor?:No
Enumeration Date:2015-01-12
Last Update Date:2022-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN11005036363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL9R3H0OtherBCBS
MS06031261Medicaid