Provider Demographics
NPI:1841494861
Name:BATH, MARTHA JANE (ARNP 9209019)
Entity type:Individual
Prefix:
First Name:MARTHA
Middle Name:JANE
Last Name:BATH
Suffix:
Gender:F
Credentials:ARNP 9209019
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8708 40TH WAY
Mailing Address - Street 2:
Mailing Address - City:PINELLAS PARK
Mailing Address - State:FL
Mailing Address - Zip Code:33782-5814
Mailing Address - Country:US
Mailing Address - Phone:727-667-2255
Mailing Address - Fax:727-577-5138
Practice Address - Street 1:8708 40TH WAY NORTH
Practice Address - Street 2:
Practice Address - City:PINELLAS PARK
Practice Address - State:FL
Practice Address - Zip Code:33782
Practice Address - Country:US
Practice Address - Phone:727-544-3900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-13
Last Update Date:2011-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP 9209019163WW0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WW0101XNursing Service ProvidersRegistered NurseWomen's Health Care, Ambulatory