Provider Demographics
NPI:1518674753
Name:MARTIN, TANIA MILDRELY (FNP)
Entity Type:Individual
Prefix:MS
First Name:TANIA
Middle Name:MILDRELY
Last Name:MARTIN
Suffix:
Gender:F
Credentials:FNP
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Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:6919 N DALE MABRY HWY STE 320
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33614-3972
Mailing Address - Country:US
Mailing Address - Phone:813-915-5555
Mailing Address - Fax:813-931-7508
Practice Address - Street 1:6919 N DALE MABRY HWY STE 320
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33614-3972
Practice Address - Country:US
Practice Address - Phone:813-915-5555
Practice Address - Fax:813-931-7508
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-27
Last Update Date:2023-05-11
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FL11022745363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily