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? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 261Q00000X | Ambulatory Health Care Facilities | Clinic/Center |