Healthcare Provider Details

I. General information

NPI: 1184838567
Provider Name (Legal Business Name): MARTHA HALSEY-LYDA APN, CDE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/09/2007
Last Update Date: 03/17/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1025 SW 1ST AVE
OCALA FL
34471-0900
US

IV. Provider business mailing address

1025 SW 1ST AVE
OCALA FL
34471-0900
US

V. Phone/Fax

Practice location:
  • Phone: 352-732-6599
  • Fax:
Mailing address:
  • Phone: 352-732-6599
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number209006482
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number9430932
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: