Provider Demographics
NPI:1962263848
Name:MARTIN, NAN ELIZABETH (DC)
Entity type:Individual
Prefix:DR
First Name:NAN
Middle Name:ELIZABETH
Last Name:MARTIN
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:107 SE BELLA STRANO
Mailing Address - Street 2:
Mailing Address - City:PORT SAINT LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34984-6605
Mailing Address - Country:US
Mailing Address - Phone:561-315-6334
Mailing Address - Fax:
Practice Address - Street 1:107 SE BELLA STRANO
Practice Address - Street 2:
Practice Address - City:PORT SAINT LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34984-6605
Practice Address - Country:US
Practice Address - Phone:561-315-6334
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-18
Last Update Date:2024-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL14881111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor