Provider Demographics
NPI:1780873869
Name:BERTIN, MARTHA LUCILLA (ARNP)
Entity type:Individual
Prefix:MRS
First Name:MARTHA
Middle Name:LUCILLA
Last Name:BERTIN
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11031 S.W. 167TH STREET
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33157-2852
Mailing Address - Country:US
Mailing Address - Phone:305-254-0574
Mailing Address - Fax:305-254-0294
Practice Address - Street 1:11030 S. W. 167TH STREET
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33157-2852
Practice Address - Country:US
Practice Address - Phone:305-254-0574
Practice Address - Fax:305-254-0294
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-15
Last Update Date:2007-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP 2497252363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily