Provider Demographics
NPI:1679596001
Name:JARAMILLO, MARTHA CECILIA (NP)
Entity Type:Individual
Prefix:MS
First Name:MARTHA
Middle Name:CECILIA
Last Name:JARAMILLO
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1350 NW 14TH ST STE 212
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33125-1609
Mailing Address - Country:US
Mailing Address - Phone:305-575-5045
Mailing Address - Fax:
Practice Address - Street 1:1350 NW 14TH ST STE 212
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33125-1609
Practice Address - Country:US
Practice Address - Phone:305-575-5045
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-26
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GANP130879363LW0102X, 363LX0001X
FLARNP9461221363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
No363LX0001XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA1679596001Medicaid