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General NPI Number Information
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NPI Number | 1619692621
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Entity Type | Individual
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Provider Name | MARTINE GUSTAVE
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Gender | Female
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Dates
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Enumeration Date | 10/11/2022
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Last Update Date | 10/11/2022
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Provider Practice Location Address
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Address Line | 1951 SW 172ND AVE STE 305
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City | MIRAMAR
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State | FL
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Zip | 33029-5614
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Country | US
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Telephone | 954-362-2720
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Fax | 954-362-2762
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Provider Business Mailing Address
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Address Line | 9675 NW 19TH PL
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City | SUNRISE
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State | FL
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Zip | 33322-3604
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Country | US
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Telephone | 786-362-0543
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 11012985
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License Number State | FL
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