Healthcare Provider Details

I. General information

NPI: 1457133126
Provider Name (Legal Business Name): CENTRAL FLORIDA BREASTFEEDING MEDICINE AND PRIMARY CARE, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/17/2023
Last Update Date: 05/22/2026
Certification Date: 05/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2020 HIGHWAY A1A STE 101
INDIAN HARBOUR BEACH FL
32937-3581
US

IV. Provider business mailing address

500 N BREVARD AVE UNIT 320504
COCOA BEACH FL
32932-7022
US

V. Phone/Fax

Practice location:
  • Phone: 321-345-0199
  • Fax: 321-616-7656
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. KELLY LYN MARTINKUS
Title or Position: PHYSICIAN/OWNER
Credential: MD
Phone: 321-345-0199