MEDICARE: MARTA ANGELICA FAIR NP

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	11046269	FL

General Provider Information

NPI Number	:	1538008875
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARTA ANGELICA FAIR NP

Provider Business Mailing Address
First Line	:	508 BOAT KEY WAY
Second Line	:
City	:	GROVELAND
State	:	FL
Zip	:	34736-8104
Country	:	US
Telephone Number	:	352-255-8889
Fax Number	:

Provider Business Practice Location Address
First Line	:	508 BOAT KEY WAY
Second Line	:
City	:	GROVELAND
State	:	FL
Zip	:	34736-8104
Country	:	US
Telephone Number	:	352-255-8889
Fax Number	:

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

Provider Enumeration Date	:	03/25/2026
Last Update Date	:	03/25/2026

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Directions to “ MARTA ANGELICA FAIR NP” Practice Location

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