Provider Demographics
NPI:1891917357
Name:MARTIN, EMILY A (PA)
Entity Type:Individual
Prefix:
First Name:EMILY
Middle Name:A
Last Name:MARTIN
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:EMILY
Other - Middle Name:A
Other - Last Name:RHODES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:38135 MARKET SQ
Mailing Address - Street 2:
Mailing Address - City:ZEPHYRHILLS
Mailing Address - State:FL
Mailing Address - Zip Code:33542-7505
Mailing Address - Country:US
Mailing Address - Phone:813-528-4975
Mailing Address - Fax:
Practice Address - Street 1:1942 HIGHLAND OAKS BLVD
Practice Address - Street 2:SUITE A
Practice Address - City:LUTZ
Practice Address - State:FL
Practice Address - Zip Code:33559-7410
Practice Address - Country:US
Practice Address - Phone:813-948-3838
Practice Address - Fax:813-949-0629
Is Sole Proprietor?:No
Enumeration Date:2007-05-03
Last Update Date:2017-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9102143363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLPA9102143OtherLICENSE #
FLP01785154-RAILROADMedicare PIN
FLPA9102143OtherLICENSE #
FLHT804Z-TPAMedicare PIN