=====================================================
General NPI Number Information
=====================================================
NPI Number | 1518674753
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | TANIA MILDRELY MARTIN FNP
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/27/2022
-----------------------------------------------------
Last Update Date | 10/30/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4700 N HABANA AVE STE 101
-----------------------------------------------------
City | TAMPA
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33614-7116
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 813-444-9599
-----------------------------------------------------
Fax | 813-513-8210
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 6675 WESTWOOD BLVD STE 475
-----------------------------------------------------
City | ORLANDO
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32821-6027
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 407-845-0330
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363L00000X
-----------------------------------------------------
Taxonomy Name | Nurse Practitioner
-----------------------------------------------------
License Number | APRN11022745
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 363LF0000X
-----------------------------------------------------
Taxonomy Name | Family Nurse Practitioner
-----------------------------------------------------
License Number | APRN11022745
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------