Provider Demographics
NPI:1982681888
Name:MARTIN, DOROTHY LYNN (ARNP)
Entity Type:Individual
Prefix:
First Name:DOROTHY
Middle Name:LYNN
Last Name:MARTIN
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:10051 5TH ST N, SUITE 200
Mailing Address - Street 2:JSA HEALTHCARE
Mailing Address - City:SAINT PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33702
Mailing Address - Country:US
Mailing Address - Phone:727-824-0780
Mailing Address - Fax:727-568-6011
Practice Address - Street 1:7800 66TH ST N STE 101
Practice Address - Street 2:JSA MEDICAL GROUP - PINELLAS PARK
Practice Address - City:PINELLAS PARK
Practice Address - State:FL
Practice Address - Zip Code:33781-2101
Practice Address - Country:US
Practice Address - Phone:727-546-5702
Practice Address - Fax:727-546-5700
Is Sole Proprietor?:No
Enumeration Date:2005-12-30
Last Update Date:2013-02-26
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLARNP815952363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL305306700Medicaid
FL305306700Medicaid