Provider Demographics
NPI:1184339301
Name:MARTIN, ALISHA (PMHNP-BC)
Entity type:Individual
Prefix:
First Name:ALISHA
Middle Name:
Last Name:MARTIN
Suffix:
Gender:F
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:29352 MEADOWCROFT LN
Mailing Address - Street 2:
Mailing Address - City:WESLEY CHAPEL
Mailing Address - State:FL
Mailing Address - Zip Code:33544-5921
Mailing Address - Country:US
Mailing Address - Phone:513-304-5961
Mailing Address - Fax:
Practice Address - Street 1:29352 MEADOWCROFT LN
Practice Address - Street 2:
Practice Address - City:WESLEY CHAPEL
Practice Address - State:FL
Practice Address - Zip Code:33544-5921
Practice Address - Country:US
Practice Address - Phone:513-304-5961
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-01-23
Last Update Date:2025-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY406754363LP0808X
FL9562959363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health