Provider Demographics
NPI:1033174735
Name:MARKS DE MARTINO, ELIZABETH ANN (MSN, ARNP)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:ANN
Last Name:MARKS DE MARTINO
Suffix:
Gender:F
Credentials:MSN, ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19050 SE 47TH PL
Mailing Address - Street 2:
Mailing Address - City:MORRISTON
Mailing Address - State:FL
Mailing Address - Zip Code:32668-3959
Mailing Address - Country:US
Mailing Address - Phone:352-528-9069
Mailing Address - Fax:
Practice Address - Street 1:1801 SE 32ND AVE
Practice Address - Street 2:
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34471-5532
Practice Address - Country:US
Practice Address - Phone:352-629-0137
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-04-18
Last Update Date:2011-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP 9215632363LP0200X
CA423106363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL306491300Medicaid