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General NPI Number Information
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NPI Number | 1285804039
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Entity Type | Organization
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Legal Business Name | SUZANNE MARTINCAK , PL
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Dates
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Enumeration Date | 03/07/2008
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Last Update Date | 03/08/2008
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Provider Practice Location Address
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Address Line | 924 W 13TH ST
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City | PANAMA CITY
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State | FL
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Zip | 32401-2214
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Country | US
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Telephone | 850-763-8643
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Fax |
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Provider Business Mailing Address
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Address Line | 521 HIGHWAY 2297
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City | PANAMA CITY
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State | FL
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Zip | 32404-2919
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Country | US
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Telephone | 850-628-1969
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Fax |
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Authorized Official
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Title or Position | NURSE PRACTIONER/ MIDWIFE
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Name | MRS. SUZANNE MARTINCAK
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Credential | ARNP
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Telephone | 850-628-1969
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 9176243
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License Number State | FL
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