Provider Demographics
NPI:1003641291
Name:MARTIAL, FRANCE LINE
Entity type:Individual
Prefix:
First Name:FRANCE LINE
Middle Name:
Last Name:MARTIAL
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 1:618 NW 46TH AVE
Mailing Address - Street 2:
Mailing Address - City:DELRAY BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33445-2117
Mailing Address - Country:US
Mailing Address - Phone:561-303-9355
Mailing Address - Fax:
Practice Address - Street 1:190 NE 199TH ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33179-2927
Practice Address - Country:US
Practice Address - Phone:786-589-7840
Practice Address - Fax:305-391-3551
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-05
Last Update Date:2024-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11034861363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner