Healthcare Provider Details

I. General information

NPI: 1457181869
Provider Name (Legal Business Name): CRISTINA MARTINE PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/02/2024
Last Update Date: 09/22/2026
Certification Date: 09/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 PINELLAS ST STE 325
CLEARWATER FL
33756-3320
US

IV. Provider business mailing address

2995 DREW ST FL 2
CLEARWATER FL
33759-3012
US

V. Phone/Fax

Practice location:
  • Phone: 727-298-6121
  • Fax:
Mailing address:
  • Phone: 727-532-0002
  • Fax: 813-635-2613

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License NumberPA9119177
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: