Provider Demographics
NPI:1407059629
Name:MARTIN, BRIDGET (ARNPC)
Entity Type:Individual
Prefix:MRS
First Name:BRIDGET
Middle Name:
Last Name:MARTIN
Suffix:
Gender:F
Credentials:ARNPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2055 SOUTH ATLANTIC AVENUE
Mailing Address - Street 2:UNIT # 801
Mailing Address - City:DAYTONA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32118
Mailing Address - Country:US
Mailing Address - Phone:706-346-1421
Mailing Address - Fax:
Practice Address - Street 1:300 71ST ST
Practice Address - Street 2:SUITE # 620
Practice Address - City:MIAMI BEACH
Practice Address - State:FL
Practice Address - Zip Code:33141-3038
Practice Address - Country:US
Practice Address - Phone:305-866-9951
Practice Address - Fax:305-614-3352
Is Sole Proprietor?:No
Enumeration Date:2007-06-06
Last Update Date:2009-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9256853163WG0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL308973800Medicaid
FLAE190YMedicare PIN