Provider Demographics
NPI:1700861945
Name:POLIZZI, MARTHA MARIA (CRNA)
Entity Type:Individual
Prefix:
First Name:MARTHA
Middle Name:MARIA
Last Name:POLIZZI
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:MARTHA
Other - Middle Name:MARIA
Other - Last Name:CAPOZZIELLO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNA
Mailing Address - Street 1:1613 NORTH HARRISON PARKWAY
Mailing Address - Street 2:SUITE 200
Mailing Address - City:SUNRISE
Mailing Address - State:FL
Mailing Address - Zip Code:33323-2583
Mailing Address - Country:US
Mailing Address - Phone:954-838-2371
Mailing Address - Fax:954-851-1746
Practice Address - Street 1:703 N. FLAMINGO ROAD
Practice Address - Street 2:SUITE A-250
Practice Address - City:PEMBROKE PINES
Practice Address - State:FL
Practice Address - Zip Code:33028
Practice Address - Country:US
Practice Address - Phone:954-436-5000
Practice Address - Fax:954-450-4449
Is Sole Proprietor?:No
Enumeration Date:2005-12-09
Last Update Date:2011-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9194063367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLG3146OtherBCBS
FL304982500Medicaid
FL304982500Medicaid