MEDICARE: NICOLE DENAE MARTIN RN

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	163WP0200X	Pediatric Registered Nurse	RN9511615	FL

General Provider Information

NPI Number	:	1427870757
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NICOLE DENAE MARTIN RN

Provider Business Mailing Address
First Line	:	16088 SE 15TH ST
Second Line	:
City	:	OCKLAWAHA
State	:	FL
Zip	:	32179-2110
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4048 DELTONA BLVD
Second Line	:
City	:	SPRING HILL
State	:	FL
Zip	:	34606-2214
Country	:	US
Telephone Number	:	352-269-8485
Fax Number	:

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

Provider Enumeration Date	:	10/28/2024
Last Update Date	:	10/28/2024

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