Healthcare Provider Details

I. General information

NPI: 1841494861
Provider Name (Legal Business Name): MARTHA JANE BATH ARNP 9209019
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/13/2007
Last Update Date: 03/25/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8708 40TH WAY NORTH
PINELLAS PARK FL
33782
US

IV. Provider business mailing address

8708 40TH WAY
PINELLAS PARK FL
33782-5814
US

V. Phone/Fax

Practice location:
  • Phone: 727-544-3900
  • Fax:
Mailing address:
  • Phone: 727-667-2255
  • Fax: 727-577-5138

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WW0101X
TaxonomyAmbulatory Women's Health Care Registered Nurse
License NumberARNP 9209019
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: