Provider Demographics
NPI:1023383023
Name:MARTIN, IDANIA (MSN, ARNP, NP-C)
Entity type:Individual
Prefix:
First Name:IDANIA
Middle Name:
Last Name:MARTIN
Suffix:
Gender:F
Credentials:MSN, ARNP, NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8145 NW 7TH ST
Mailing Address - Street 2:APT 504
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33126-8004
Mailing Address - Country:US
Mailing Address - Phone:305-308-9937
Mailing Address - Fax:
Practice Address - Street 1:4835 E 4TH AVE
Practice Address - Street 2:SUITE B
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33013-1814
Practice Address - Country:US
Practice Address - Phone:305-308-9937
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-09
Last Update Date:2013-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRN9279693163W00000X
FLARNP9279693363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No163W00000XNursing Service ProvidersRegistered Nurse