Provider Demographics
NPI:1376632919
Name:MARTIN, REBECCA DAWN (ARNP)
Entity Type:Individual
Prefix:MRS
First Name:REBECCA
Middle Name:DAWN
Last Name:MARTIN
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 1:10575 68TH AVE STE A2
Mailing Address - Street 2:
Mailing Address - City:SEMINOLE
Mailing Address - State:FL
Mailing Address - Zip Code:33772-6023
Mailing Address - Country:US
Mailing Address - Phone:727-272-1844
Mailing Address - Fax:877-422-2920
Practice Address - Street 1:10575 68TH AVE STE A2
Practice Address - Street 2:
Practice Address - City:SEMINOLE
Practice Address - State:FL
Practice Address - Zip Code:33772-6023
Practice Address - Country:US
Practice Address - Phone:727-272-1844
Practice Address - Fax:877-422-2920
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-12
Last Update Date:2018-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP2736202261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLE1557YMedicare ID - Type Unspecified
FLS67241Medicare UPIN