Provider Demographics
NPI:1598263139
Name:MARTIN, MERCEDES Y (ARNP)
Entity Type:Individual
Prefix:
First Name:MERCEDES
Middle Name:Y
Last Name:MARTIN
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 1:13275 SW 124TH ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33186-6408
Mailing Address - Country:US
Mailing Address - Phone:305-828-5310
Mailing Address - Fax:305-822-9158
Practice Address - Street 1:13275 SW 124TH ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33186-6408
Practice Address - Country:US
Practice Address - Phone:305-828-5310
Practice Address - Fax:305-822-9158
Is Sole Proprietor?:No
Enumeration Date:2018-01-29
Last Update Date:2018-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9375622363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner