Provider Demographics
NPI:1073702031
Name:MARTINO, AMY ZACCARIA (MD)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:ZACCARIA
Last Name:MARTINO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2410
Mailing Address - Street 2:
Mailing Address - City:LARGO
Mailing Address - State:FL
Mailing Address - Zip Code:33779-2410
Mailing Address - Country:US
Mailing Address - Phone:727-581-8706
Mailing Address - Fax:727-588-2447
Practice Address - Street 1:501 N HOWARD AVE STE 100
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33606-1213
Practice Address - Country:US
Practice Address - Phone:727-581-8706
Practice Address - Fax:727-588-2447
Is Sole Proprietor?:No
Enumeration Date:2007-10-16
Last Update Date:2020-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME109554207WX0009X, 207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
No207WX0009XAllopathic & Osteopathic PhysiciansOphthalmologyGlaucoma Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL003923500Medicaid
FLFG216VMedicare PIN