MEDICARE: MRS. BRIDGET MARTIN ARNPC

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	163WG0000X	General Practice Registered Nurse	ARNP9256853	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1407059629
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. BRIDGET MARTIN ARNPC

Provider Business Mailing Address
First Line	:	2055 SOUTH ATLANTIC AVENUE
Second Line	:	UNIT # 801
City	:	DAYTONA BEACH
State	:	FL
Zip	:	32118
Country	:	US
Telephone Number	:	706-346-1421
Fax Number	:

Provider Business Practice Location Address
First Line	:	300 71ST ST
Second Line	:	SUITE # 620
City	:	MIAMI BEACH
State	:	FL
Zip	:	33141-3038
Country	:	US
Telephone Number	:	305-866-9951
Fax Number	:	305-614-3352

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

Provider Enumeration Date	:	06/06/2007
Last Update Date	:	06/25/2009

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