Provider Demographics
NPI:1700290509
Name:MARTINKUS, KELLY LYN (MD)
Entity Type:Individual
Prefix:DR
First Name:KELLY
Middle Name:LYN
Last Name:MARTINKUS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:601 S HARBOUR ISLAND BLVD STE 200
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33602-5925
Mailing Address - Country:US
Mailing Address - Phone:727-322-3439
Mailing Address - Fax:800-928-7449
Practice Address - Street 1:840 N COCOA BLVD STE E-F
Practice Address - Street 2:
Practice Address - City:COCOA
Practice Address - State:FL
Practice Address - Zip Code:32922-7590
Practice Address - Country:US
Practice Address - Phone:321-522-4000
Practice Address - Fax:844-388-6186
Is Sole Proprietor?:No
Enumeration Date:2014-06-19
Last Update Date:2022-08-12
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PR18779208D00000X
FLACN824208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL018007500Medicaid