Provider Demographics
NPI:1932142403
Name:SMALL, MARTHA CECILIA
Entity Type:Individual
Prefix:MS
First Name:MARTHA
Middle Name:CECILIA
Last Name:SMALL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7151 HARDING ST
Mailing Address - Street 2:
Mailing Address - City:HOLLYWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:33024-3827
Mailing Address - Country:US
Mailing Address - Phone:954-297-1189
Mailing Address - Fax:954-987-1135
Practice Address - Street 1:7151 HARDING ST
Practice Address - Street 2:
Practice Address - City:HOLLYWOOD
Practice Address - State:FL
Practice Address - Zip Code:33024-3827
Practice Address - Country:US
Practice Address - Phone:954-297-1189
Practice Address - Fax:954-987-1135
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-13
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRN2579852163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health