Provider Demographics
NPI:1861472912
Name:SOLOMON, MARLA RANDI (CNM)
Entity Type:Individual
Prefix:
First Name:MARLA
Middle Name:RANDI
Last Name:SOLOMON
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 452345
Mailing Address - Street 2:
Mailing Address - City:SUNRISE
Mailing Address - State:FL
Mailing Address - Zip Code:33345-2345
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:12651 W SUNRISE BLVD
Practice Address - Street 2:SUITE #104
Practice Address - City:SUNRISE
Practice Address - State:FL
Practice Address - Zip Code:33323-0906
Practice Address - Country:US
Practice Address - Phone:954-835-0940
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-01-17
Last Update Date:2007-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP2164542367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLY6355OMedicare PIN
FLY6357TMedicare PIN
FLY6357VMedicare PIN
FLY6355Medicare PIN
FLY6357RMedicare PIN
FLY6357PMedicare PIN
FLY6357UMedicare PIN
FLY6357XMedicare PIN
FLY6356ZMedicare PIN
FLY6357WMedicare PIN
FLY6357QMedicare PIN
Y6357YMedicare PIN
FLY6357SMedicare PIN