Healthcare Provider Details

I. General information

NPI: 1891247532
Provider Name (Legal Business Name): MARTIN ESUZOR
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/28/2016
Last Update Date: 10/28/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7918 HILLSBOROUGH AVENUE
TAMPA FL
33615
US

IV. Provider business mailing address

7918 WEST HILLSBOROUGH AVENUE
TAMPA FL
33615
US

V. Phone/Fax

Practice location:
  • Phone: 813-374-7004
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberARNP3380082
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: