Provider Demographics
NPI:1790339893
Name:MARTELL POLO, ERNESTO (PA)
Entity Type:Individual
Prefix:
First Name:ERNESTO
Middle Name:
Last Name:MARTELL POLO
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:8477 S SUNCOAST BLVD
Mailing Address - Street 2:
Mailing Address - City:HOMOSASSA
Mailing Address - State:FL
Mailing Address - Zip Code:34446-5028
Mailing Address - Country:US
Mailing Address - Phone:352-382-7214
Mailing Address - Fax:
Practice Address - Street 1:4302 ALTON RD STE 220
Practice Address - Street 2:
Practice Address - City:MIAMI BEACH
Practice Address - State:FL
Practice Address - Zip Code:33140-2818
Practice Address - Country:US
Practice Address - Phone:305-674-2090
Practice Address - Fax:305-674-2093
Is Sole Proprietor?:No
Enumeration Date:2019-07-26
Last Update Date:2023-07-27
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLPA9114867363A00000X, 363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant