Provider Demographics
NPI:1316185945
Name:MARTIN, ALICE DARLENE (RN)
Entity Type:Individual
Prefix:MR
First Name:ALICE
Middle Name:DARLENE
Last Name:MARTIN
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:729 PRESTWICK DR
Mailing Address - Street 2:
Mailing Address - City:NICEVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32578-3858
Mailing Address - Country:US
Mailing Address - Phone:850-897-2545
Mailing Address - Fax:
Practice Address - Street 1:729 PRESTWICK DR
Practice Address - Street 2:
Practice Address - City:NICEVILLE
Practice Address - State:FL
Practice Address - Zip Code:32578-3858
Practice Address - Country:US
Practice Address - Phone:850-897-2545
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-02-04
Last Update Date:2009-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRN9202038163WD0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WD0400XNursing Service ProvidersRegistered NurseDiabetes Educator