Provider Demographics
NPI:1336751585
Name:SALTER, MARTA MAUNEY (NP-C)
Entity Type:Individual
Prefix:
First Name:MARTA
Middle Name:MAUNEY
Last Name:SALTER
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19 WATCH TOWER LN N
Mailing Address - Street 2:
Mailing Address - City:WATERSOUND
Mailing Address - State:FL
Mailing Address - Zip Code:32461-8536
Mailing Address - Country:US
Mailing Address - Phone:904-477-1457
Mailing Address - Fax:
Practice Address - Street 1:1827 HARRISON AVE
Practice Address - Street 2:
Practice Address - City:PANAMA CITY
Practice Address - State:FL
Practice Address - Zip Code:32405-7605
Practice Address - Country:US
Practice Address - Phone:850-785-4344
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-19
Last Update Date:2020-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11008744363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner