Provider Demographics
NPI:1679120737
Name:TRAVIESO, MARTHA (APRN, CNM)
Entity Type:Individual
Prefix:
First Name:MARTHA
Middle Name:
Last Name:TRAVIESO
Suffix:
Gender:F
Credentials:APRN, CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10281 CAROLINE PARK DR
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32832-5864
Mailing Address - Country:US
Mailing Address - Phone:347-304-5955
Mailing Address - Fax:
Practice Address - Street 1:11399 LAKE UNDERHILL RD
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32825-5023
Practice Address - Country:US
Practice Address - Phone:407-207-6768
Practice Address - Fax:407-249-5025
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-23
Last Update Date:2022-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11003824367A00000X
FLAPRN11003824367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife