MEDICARE: SUZANNE MARTINCAK , PL

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	363LF0000X	Family Nurse Practitioner	9176243	FL

General Provider Information

NPI Number	:	1285804039
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SUZANNE MARTINCAK , PL

Provider Business Mailing Address
First Line	:	521 HIGHWAY 2297
Second Line	:
City	:	PANAMA CITY
State	:	FL
Zip	:	32404-2919
Country	:	US
Telephone Number	:	850-628-1969
Fax Number	:

Provider Business Practice Location Address
First Line	:	924 W 13TH ST
Second Line	:
City	:	PANAMA CITY
State	:	FL
Zip	:	32401-2214
Country	:	US
Telephone Number	:	850-763-8643
Fax Number	:

Authorized Official
Title or Position	:	NURSE PRACTIONER/ MIDWIFE
Name	:	MRS. SUZANNE MARTINCAK
Credential	:	ARNP
Telephone Number	:	850-628-1969

Provider Enumeration Date	:	03/07/2008
Last Update Date	:	03/08/2008

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