MEDICARE: MARTHA IVANIA BRAVO NP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	APRN9275499	FL
2	163WE0003X	Emergency Registered Nurse	RN9275499	FL
3	363LF0000X	Family Nurse Practitioner	9275499	FL

General Provider Information

NPI Number	:	1063907426
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARTHA IVANIA BRAVO NP

Provider Business Mailing Address
First Line	:	13236 SW 86TH LN
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33183-4159
Country	:	US
Telephone Number	:	786-382-4605
Fax Number	:

Provider Business Practice Location Address
First Line	:	13236 SW 86TH LN
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33183-4159
Country	:	US
Telephone Number	:	786-382-4605
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/28/2018
Last Update Date	:	05/11/2021

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