MEDICARE: MARYANN MARTIN N.P.

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	363LA2100X	Acute Care Nurse Practitioner	ARNP9168017	FL

General Provider Information

NPI Number	:	1578550935
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARYANN MARTIN N.P.

Provider Business Mailing Address
First Line	:	1051 PORT MALABAR BLVD NE
Second Line	:	SUITE 6, PORT MALABAR PROFESSIONAL BLDG
City	:	PALM BAY
State	:	FL
Zip	:	32905-5153
Country	:	US
Telephone Number	:	321-727-9063
Fax Number	:

Provider Business Practice Location Address
First Line	:	1051 PORT MALABAR BLVD NE
Second Line	:	SUITE 6, PORT MALABAR PROFESSIONAL BLDG
City	:	PALM BAY
State	:	FL
Zip	:	32905-5153
Country	:	US
Telephone Number	:	321-727-9063
Fax Number	:

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

Provider Enumeration Date	:	09/30/2005
Last Update Date	:	07/08/2007

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