MEDICARE: CRISTINA MARTINE PA-C

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	363A00000X	Physician Assistant
2	207T00000X	Neurological Surgery Physician	PA9119177	FL

General Provider Information

NPI Number	:	1457181869
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CRISTINA MARTINE PA-C

Provider Business Mailing Address
First Line	:	2290 10TH AVE N STE 401
Second Line	:
City	:	LAKE WORTH
State	:	FL
Zip	:	33461-6609
Country	:	US
Telephone Number	:	561-284-8455
Fax Number	:	561-284-8775

Provider Business Practice Location Address
First Line	:	2290 10TH AVE N STE 401
Second Line	:
City	:	LAKE WORTH
State	:	FL
Zip	:	33461-6609
Country	:	US
Telephone Number	:	561-284-8455
Fax Number	:	561-284-8775

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

Provider Enumeration Date	:	08/02/2024
Last Update Date	:	01/27/2026

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Directions to “ CRISTINA MARTINE PA-C” Practice Location

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