Provider Demographics
NPI:1477936441
Name:MARTIN, JAMILA RONIQUE
Entity Type:Individual
Prefix:
First Name:JAMILA
Middle Name:RONIQUE
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 1:5537 PGA BLVD
Mailing Address - Street 2:APT. 4511
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32839-3561
Mailing Address - Country:US
Mailing Address - Phone:850-590-8102
Mailing Address - Fax:
Practice Address - Street 1:5537 PGA BLVD
Practice Address - Street 2:APT. 4511
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32839-3561
Practice Address - Country:US
Practice Address - Phone:850-590-8102
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-08
Last Update Date:2015-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator