Provider Demographics
NPI:1538704580
Name:OBANDO, MARTHA LORENA (MSN, APRN, FNC-BC)
Entity Type:Individual
Prefix:MRS
First Name:MARTHA
Middle Name:LORENA
Last Name:OBANDO
Suffix:
Gender:F
Credentials:MSN, APRN, FNC-BC
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 668035
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33166-9409
Mailing Address - Country:US
Mailing Address - Phone:786-441-4736
Mailing Address - Fax:
Practice Address - Street 1:16324 SW 15TH ST
Practice Address - Street 2:
Practice Address - City:PEMBROKE PINES
Practice Address - State:FL
Practice Address - Zip Code:33027-5126
Practice Address - Country:US
Practice Address - Phone:786-441-4736
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-11-14
Last Update Date:2019-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN11005118363LP2300X
FLRN9363418363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily