Provider Demographics
NPI:1457133126
Name:CENTRAL FLORIDA BREASTFEEDING MEDICINE AND PRIMARY CARE, PLLC
Entity Type:Organization
Organization Name:CENTRAL FLORIDA BREASTFEEDING MEDICINE AND PRIMARY CARE, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KELLY
Authorized Official - Middle Name:LYN
Authorized Official - Last Name:MARTINKUS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:321-345-0199
Mailing Address - Street 1:500 N BREVARD AVE UNIT 320504
Mailing Address - Street 2:
Mailing Address - City:COCOA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32932-7022
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2020 HIGHWAY A1A STE 101
Practice Address - Street 2:
Practice Address - City:INDIAN HARBOUR BEACH
Practice Address - State:FL
Practice Address - Zip Code:32937-3581
Practice Address - Country:US
Practice Address - Phone:321-345-0199
Practice Address - Fax:321-616-7656
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-10-17
Last Update Date:2023-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center