Healthcare Provider Details

I. General information

NPI: 1427711266
Provider Name (Legal Business Name): BETHANY JOY MARTIN PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/19/2021
Last Update Date: 08/05/2024
Certification Date: 08/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2415 UNIVERSITY PKWY STE 219
SARASOTA FL
34243-2809
US

IV. Provider business mailing address

2415 UNIVERSITY PKWY STE 219
SARASOTA FL
34243-2809
US

V. Phone/Fax

Practice location:
  • Phone: 941-413-0834
  • Fax:
Mailing address:
  • Phone: 941-413-0834
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA9114977
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: