Provider Demographics
NPI:1972690972
Name:CULLEN, MARTHA N (APRN)
Entity Type:Individual
Prefix:MS
First Name:MARTHA
Middle Name:N
Last Name:CULLEN
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 1:701 MONASTERY RD FL 32763
Mailing Address - Street 2:
Mailing Address - City:ORANGE CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32763-6222
Mailing Address - Country:US
Mailing Address - Phone:386-456-1600
Mailing Address - Fax:386-456-1550
Practice Address - Street 1:701 MONASTERY RD
Practice Address - Street 2:
Practice Address - City:ORANGE CITY
Practice Address - State:FL
Practice Address - Zip Code:32763
Practice Address - Country:US
Practice Address - Phone:386-456-1600
Practice Address - Fax:386-456-1550
Is Sole Proprietor?:No
Enumeration Date:2006-10-10
Last Update Date:2022-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN1568282363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM70193OtherCNP LICENSE
NH089741-23OtherAPRN LICENSE
FL1568282OtherLICENSE
FLP00360118OtherRAILROAD MEDICARE