MEDICARE: MRS. JAMI NICOLE MARTINEZ-MALDONADO 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	363LF0000X	Family Nurse Practitioner	ARNP9356315	FL

General Provider Information

NPI Number	:	1568992089
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. JAMI NICOLE MARTINEZ-MALDONADO ARNP

Provider Business Mailing Address
First Line	:	12920 EARLY RUN LN
Second Line	:
City	:	RIVERVIEW
State	:	FL
Zip	:	33578-3383
Country	:	US
Telephone Number	:	813-965-6062
Fax Number	:	813-574-7145

Provider Business Practice Location Address
First Line	:	4874 SUN CITY CENTER BLVD
Second Line	:
City	:	SUN CITY CENTER
State	:	FL
Zip	:	33573-6281
Country	:	US
Telephone Number	:	813-633-2000
Fax Number	:

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

Provider Enumeration Date	:	06/18/2017
Last Update Date	:	06/18/2017

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