Healthcare Provider Details

I. General information

NPI: 1538704580
Provider Name (Legal Business Name): MARTHA LORENA OBANDO MSN, APRN, FNC-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/14/2019
Last Update Date: 11/18/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16324 SW 15TH ST
PEMBROKE PINES FL
33027-5126
US

IV. Provider business mailing address

PO BOX 668035
MIAMI FL
33166-9409
US

V. Phone/Fax

Practice location:
  • Phone: 786-441-4736
  • Fax:
Mailing address:
  • Phone: 786-441-4736
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License NumberAPRN11005118
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN9363418
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: