Healthcare Provider Details

I. General information

NPI: 1447579172
Provider Name (Legal Business Name): REBECCA LYNN MARTIN ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/20/2010
Last Update Date: 06/16/2021
Certification Date: 06/16/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5717 21ST AVE W
BRADENTON FL
34209
US

IV. Provider business mailing address

5717 21ST AVE W
BRADENTON FL
34209
US

V. Phone/Fax

Practice location:
  • Phone: 941-792-8383
  • Fax: 941-792-8484
Mailing address:
  • Phone: 941-792-8383
  • Fax: 419-792-8484

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number532713-1
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberF336359-1
License Number StateNY
# 3
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberARNP9405008
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: