Provider Demographics
NPI:1902013030
Name:MARTIN, MICHELLE LOUISE
Entity Type:Individual
Prefix:MS
First Name:MICHELLE
Middle Name:LOUISE
Last Name:MARTIN
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:MICHELLE
Other - Middle Name:LOUISE
Other - Last Name:MARTIN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:ARNP
Mailing Address - Street 1:3440 NE 192ND ST
Mailing Address - Street 2:#A 4J
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33180-2400
Mailing Address - Country:US
Mailing Address - Phone:305-585-7600
Mailing Address - Fax:
Practice Address - Street 1:3440 NE 192ND STREET
Practice Address - Street 2:
Practice Address - City:NORTH MIAMI BEACH
Practice Address - State:FL
Practice Address - Zip Code:33180
Practice Address - Country:US
Practice Address - Phone:305-542-4085
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL2677232363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily