Provider Demographics
NPI:1396387122
Name:KENT, MARTIN (PA-C)
Entity Type:Individual
Prefix:
First Name:MARTIN
Middle Name:
Last Name:KENT
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 VIA LUGANO CIR APT 107
Mailing Address - Street 2:
Mailing Address - City:BOYNTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33436-7157
Mailing Address - Country:US
Mailing Address - Phone:801-361-4983
Mailing Address - Fax:
Practice Address - Street 1:1950 ARLINGTON ST STE 400
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34239-3513
Practice Address - Country:US
Practice Address - Phone:941-917-4250
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-10-14
Last Update Date:2023-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9112575363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant