Healthcare Provider Details

I. General information

NPI: 1679120737
Provider Name (Legal Business Name): MARTHA TRAVIESO APRN, CNM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/23/2019
Last Update Date: 12/09/2022
Certification Date: 12/09/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11399 LAKE UNDERHILL RD
ORLANDO FL
32825-5023
US

IV. Provider business mailing address

10281 CAROLINE PARK DR
ORLANDO FL
32832-5864
US

V. Phone/Fax

Practice location:
  • Phone: 407-207-6768
  • Fax: 407-249-5025
Mailing address:
  • Phone: 347-304-5955
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License Number11003824
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License NumberAPRN11003824
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: