Provider Demographics
NPI:1508355199
Name:PARKER, MARTINE NICOLE (RN)
Entity Type:Individual
Prefix:
First Name:MARTINE
Middle Name:NICOLE
Last Name:PARKER
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8833 PERIMETER PARK BLVD STE 1004
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32216-1114
Mailing Address - Country:US
Mailing Address - Phone:904-328-6749
Mailing Address - Fax:904-503-1960
Practice Address - Street 1:8833 PERIMETER PARK BLVD STE 1004
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32216-1114
Practice Address - Country:US
Practice Address - Phone:904-328-6749
Practice Address - Fax:904-503-1960
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-09
Last Update Date:2018-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRN9278478163W00000X, 163WA2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No163WA2000XNursing Service ProvidersRegistered NurseAdministrator