Provider Demographics
NPI:1780145086
Name:MARTIN, AMBERLY R (FNP-BC)
Entity type:Individual
Prefix:MRS
First Name:AMBERLY
Middle Name:R
Last Name:MARTIN
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:MS
Other - First Name:AMBERLY
Other - Middle Name:R
Other - Last Name:ARRIGO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1400 S ORANGE AVE
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32806-2134
Mailing Address - Country:US
Mailing Address - Phone:407-648-3800
Mailing Address - Fax:407-425-5203
Practice Address - Street 1:1400 S ORANGE AVE
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32806-2134
Practice Address - Country:US
Practice Address - Phone:407-648-3800
Practice Address - Fax:407-425-5203
Is Sole Proprietor?:No
Enumeration Date:2019-03-28
Last Update Date:2020-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN207544163W00000X
FL11001920363LF0000X
FLAPRN11001920363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No163W00000XNursing Service ProvidersRegistered Nurse
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL105578700Medicaid