Provider Demographics
NPI:1134977663
Name:BADA MARTINEZ, MILEIDIS
Entity type:Individual
Prefix:
First Name:MILEIDIS
Middle Name:
Last Name:BADA MARTINEZ
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 1:1032 COCHRAN DR
Mailing Address - Street 2:
Mailing Address - City:LAKE WORTH BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33461-5713
Mailing Address - Country:US
Mailing Address - Phone:561-713-3100
Mailing Address - Fax:
Practice Address - Street 1:1032 COCHRAN DR
Practice Address - Street 2:
Practice Address - City:LAKE WORTH BEACH
Practice Address - State:FL
Practice Address - Zip Code:33461-5713
Practice Address - Country:US
Practice Address - Phone:561-713-3100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-09
Last Update Date:2024-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN11032719363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily