Provider Demographics
NPI:1972646529
Name:MARTIN, PATRICIA M (CRNA)
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:M
Last Name:MARTIN
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:722 NW 36TH AVE
Mailing Address - Street 2:
Mailing Address - City:CAPE CORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33993-5601
Mailing Address - Country:US
Mailing Address - Phone:239-939-2622
Mailing Address - Fax:239-939-0151
Practice Address - Street 1:12511 WORLD PLAZA LN BLDG 50
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33907-3991
Practice Address - Country:US
Practice Address - Phone:239-939-2622
Practice Address - Fax:239-939-0151
Is Sole Proprietor?:No
Enumeration Date:2007-02-14
Last Update Date:2013-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP3286392367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLG4261OtherBLUE CROSS
591783920OtherEIN