Healthcare Provider Details

I. General information

NPI: 1982250304
Provider Name (Legal Business Name): COURTNEY ELIZABETH MARTIN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/12/2019
Last Update Date: 07/25/2025
Certification Date: 07/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8900 N KENDALL DR
MIAMI FL
33176-2118
US

IV. Provider business mailing address

3227 VIRGINIA ST
MIAMI FL
33133-5217
US

V. Phone/Fax

Practice location:
  • Phone: 786-596-3621
  • Fax:
Mailing address:
  • Phone: 305-484-8389
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code367H00000X
TaxonomyAnesthesiologist Assistant
License Number
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code367H00000X
TaxonomyAnesthesiologist Assistant
License NumberAA522
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: