Provider Demographics
NPI:1679844575
Name:MARTIN, JOSHUA ANTHONY (PA-C)
Entity Type:Individual
Prefix:
First Name:JOSHUA
Middle Name:ANTHONY
Last Name:MARTIN
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3250 ZEMKE AVE BLDG 1078
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33621-5023
Mailing Address - Country:US
Mailing Address - Phone:813-827-9870
Mailing Address - Fax:813-828-1983
Practice Address - Street 1:3250 ZEMKE AVE BLDG 1078
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33621-5023
Practice Address - Country:US
Practice Address - Phone:813-827-9870
Practice Address - Fax:813-828-6910
Is Sole Proprietor?:No
Enumeration Date:2012-01-24
Last Update Date:2023-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1679844575363A00000X
PAMA056823363A00000X
FLPA9106228363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant