Healthcare Provider Details

I. General information

NPI: 1972768877
Provider Name (Legal Business Name): MARTHA GEORGIAN APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/21/2008
Last Update Date: 09/21/2026
Certification Date: 09/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10025 SW 162ND PATH
MIAMI FL
33196-5912
US

IV. Provider business mailing address

10025 SW 162ND PATH
MIAMI FL
33196-5912
US

V. Phone/Fax

Practice location:
  • Phone: 305-389-9339
  • Fax:
Mailing address:
  • Phone: 305-389-9339
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN11050313
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License NumberND 4476
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: