MEDICARE: MRS. OLGA EMILIA MARTINEZ BOHAN ARNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LP2300X	Primary Care Nurse Practitioner	9339667	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	9339667	OTHER	FL	STATE LICENSE NUMBER

General Provider Information

NPI Number	:	1174986038
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. OLGA EMILIA MARTINEZ BOHAN ARNP

Provider Business Mailing Address
First Line	:	2289 HANNAH WAY S
Second Line	:
City	:	DUNEDIN
State	:	FL
Zip	:	34698-9452
Country	:	US
Telephone Number	:	727-781-5976
Fax Number	:

Provider Business Practice Location Address
First Line	:	12685 STARKEY RD
Second Line	:
City	:	LARGO
State	:	FL
Zip	:	33773-1421
Country	:	US
Telephone Number	:	727-535-9901
Fax Number	:	727-535-8760

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/29/2016
Last Update Date	:	03/29/2016

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