Healthcare Provider Details

I. General information

NPI: 1881339216
Provider Name (Legal Business Name): MORGAN RAE MARTIN FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/30/2022
Last Update Date: 04/30/2022
Certification Date: 04/13/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1965 CAPITAL CIR NE
TALLAHASSEE FL
32308-8401
US

IV. Provider business mailing address

1150 BRAFFORTON DR
TALLAHASSEE FL
32311-0711
US

V. Phone/Fax

Practice location:
  • Phone: 850-656-2006
  • Fax:
Mailing address:
  • Phone: 850-510-5164
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number11019475
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: