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General NPI Number Information
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NPI Number | 1043766264
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Entity Type | Individual
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Provider Name | MRS. MARTINE PHILLIPS
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Gender | Female
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Dates
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Enumeration Date | 08/28/2016
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Last Update Date | 09/19/2020
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Provider Practice Location Address
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Address Line | 2750 N. UNIVERSITY DR.
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City | DAVIE
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State | FL
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Zip | 33024-2546
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Country | US
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Telephone | 954-804-6607
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Fax |
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Provider Business Mailing Address
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Address Line | 2131 HOLLYWOOD BLVD STE 405
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City | HOLLYWOOD
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State | FL
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Zip | 33020-6787
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Country | US
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Telephone | 954-804-6607
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | APRN9168061
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License Number State | FL
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