Healthcare Provider Details

I. General information

NPI: 1366834970
Provider Name (Legal Business Name): MARTINE VEDRINE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/19/2015
Last Update Date: 06/10/2026
Certification Date: 06/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6887 W COMMERCIAL BLVD
TAMARAC FL
33319
US

IV. Provider business mailing address

6887 W COMMERCIAL BLVD
TAMARAC FL
33319-2154
US

V. Phone/Fax

Practice location:
  • Phone: 954-953-8891
  • Fax: 954-953-8893
Mailing address:
  • Phone: 954-953-8891
  • Fax: 954-953-8893

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN9226348
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License NumberARNP9226348
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: