Healthcare Provider Details

I. General information

NPI: 1396387122
Provider Name (Legal Business Name): MARTIN KENT PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/14/2019
Last Update Date: 10/09/2023
Certification Date: 10/09/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1950 ARLINGTON ST STE 400
SARASOTA FL
34239-3513
US

IV. Provider business mailing address

100 VIA LUGANO CIR APT 107
BOYNTON BEACH FL
33436-7157
US

V. Phone/Fax

Practice location:
  • Phone: 941-917-4250
  • Fax:
Mailing address:
  • Phone: 801-361-4983
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number9112575
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: