Provider Demographics
NPI:1093387276
Name:MARTIN, MARIVEL P
Entity Type:Individual
Prefix:
First Name:MARIVEL
Middle Name:P
Last Name:MARTIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13203 WHISPERING PALMS PL SW APT 903
Mailing Address - Street 2:
Mailing Address - City:LARGO
Mailing Address - State:FL
Mailing Address - Zip Code:33774-2504
Mailing Address - Country:US
Mailing Address - Phone:805-513-9088
Mailing Address - Fax:
Practice Address - Street 1:13203 WHISPERING PALMS PL SW APT 903
Practice Address - Street 2:
Practice Address - City:LARGO
Practice Address - State:FL
Practice Address - Zip Code:33774-2504
Practice Address - Country:US
Practice Address - Phone:805-513-9088
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-15
Last Update Date:2021-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL236837376J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes376J00000XNursing Service Related ProvidersHomemakerGroup - Single Specialty