Provider Demographics
NPI:1972191831
Name:MARTIN, MONICA (APRN)
Entity Type:Individual
Prefix:MRS
First Name:MONICA
Middle Name:
Last Name:MARTIN
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7458 PINE FOREST RD
Mailing Address - Street 2:
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32526-8818
Mailing Address - Country:US
Mailing Address - Phone:850-494-4600
Mailing Address - Fax:850-941-0084
Practice Address - Street 1:7458 PINE FOREST RD
Practice Address - Street 2:
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32526-8818
Practice Address - Country:US
Practice Address - Phone:850-494-4600
Practice Address - Fax:850-941-0084
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-06
Last Update Date:2021-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9371116207Q00000X
FLAPRN11010989363LP2300X
FL11010989363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary CareGroup - Single Specialty