Provider Demographics
NPI:1083709273
Name:PADILLA, MARTHA ELIZABETH (ARNP)
Entity Type:Individual
Prefix:MRS
First Name:MARTHA
Middle Name:ELIZABETH
Last Name:PADILLA
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 1:365 GRAND CONCOURSE
Mailing Address - Street 2:
Mailing Address - City:MIAMI SHORES
Mailing Address - State:FL
Mailing Address - Zip Code:33138-4276
Mailing Address - Country:US
Mailing Address - Phone:305-759-8532
Mailing Address - Fax:
Practice Address - Street 1:1201 NW 16TH STREET,
Practice Address - Street 2:112
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33125-0000
Practice Address - Country:US
Practice Address - Phone:305-575-7000
Practice Address - Fax:305-575-3255
Is Sole Proprietor?:No
Enumeration Date:2006-10-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1651912363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health