Provider Demographics
NPI:1922048875
Name:NIMETH, MARTINA MARIE (PA-C)
Entity Type:Individual
Prefix:
First Name:MARTINA
Middle Name:MARIE
Last Name:NIMETH
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 ALEXANDRIA BLVD
Mailing Address - Street 2:SUITE 1
Mailing Address - City:OVIEDO
Mailing Address - State:FL
Mailing Address - Zip Code:32765-8298
Mailing Address - Country:US
Mailing Address - Phone:407-359-7997
Mailing Address - Fax:407-359-6662
Practice Address - Street 1:100 ALEXANDRIA BLVD
Practice Address - Street 2:SUITE 1
Practice Address - City:OVIEDO
Practice Address - State:FL
Practice Address - Zip Code:32765-8298
Practice Address - Country:US
Practice Address - Phone:407-359-7997
Practice Address - Fax:407-359-6662
Is Sole Proprietor?:No
Enumeration Date:2006-06-08
Last Update Date:2008-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9102555363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLQ43718Medicare UPIN
FLU4774ZMedicare ID - Type Unspecified