Healthcare Provider Details

I. General information

NPI: 1568377844
Provider Name (Legal Business Name): JELSHON L. MARTIN MSN, APRN, FNP-C
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/19/2026
Last Update Date: 08/21/2026
Certification Date: 08/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4601 NW 77TH AVE
MIAMI FL
33166-6449
US

IV. Provider business mailing address

1851 SW 24TH ST
MIAMI FL
33145-3833
US

V. Phone/Fax

Practice location:
  • Phone: 305-283-4051
  • Fax:
Mailing address:
  • Phone: 305-283-4051
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WC0400X
TaxonomyCase Management Registered Nurse
License NumberRN9579864
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code163WS0200X
TaxonomySchool Registered Nurse
License NumberAPRN11034782
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN11034782
License Number StateFL
# 4
Primary TaxonomyY
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License NumberAPRN11034782
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: