Provider Demographics
NPI:1497779227
Name:DEMARTINI, MARY ELLEN T (ARNP)
Entity Type:Individual
Prefix:MRS
First Name:MARY ELLEN
Middle Name:T
Last Name:DEMARTINI
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:PO BOX 2147
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33902-2147
Mailing Address - Country:US
Mailing Address - Phone:239-343-1953
Mailing Address - Fax:239-343-4036
Practice Address - Street 1:6630 ORION DR STE 302
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33912-4441
Practice Address - Country:US
Practice Address - Phone:239-343-1953
Practice Address - Fax:239-343-4036
Is Sole Proprietor?:No
Enumeration Date:2006-07-26
Last Update Date:2021-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJNN08668363LF0000X
FLARNP9267232363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL308871500Medicaid
NJS62191Medicare UPIN
FL308871500Medicaid
NJ015746CNMMedicare ID - Type Unspecified