Provider Demographics
NPI:1548583149
Name:PARRISH, MARTHA M (ARNP)
Entity Type:Individual
Prefix:
First Name:MARTHA
Middle Name:M
Last Name:PARRISH
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:MARTHA
Other - Middle Name:A
Other - Last Name:MONTAGUE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ARNP
Mailing Address - Street 1:PO BOX 2699
Mailing Address - Street 2:HPE
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32513-2699
Mailing Address - Country:US
Mailing Address - Phone:850-416-7119
Mailing Address - Fax:850-416-6142
Practice Address - Street 1:5153 N 9TH AVE
Practice Address - Street 2:STE 307
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32504-8785
Practice Address - Country:US
Practice Address - Phone:850-416-7119
Practice Address - Fax:850-416-6142
Is Sole Proprietor?:No
Enumeration Date:2010-03-10
Last Update Date:2013-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9248170363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL000395000Medicaid