MEDICARE: CYNTHIA ANN MARTIN CPNP

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	363LP0200X	Pediatric Nurse Practitioner	087000407N2 PNP	OR
2	363L00000X	Nurse Practitioner	ARNP9412611	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
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1912993353
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CYNTHIA ANN MARTIN CPNP

Provider Business Mailing Address
First Line	:	1501 SAN PEDRO DR SE BLDG 47
Second Line	:	SGOMP/PEDIATRIC CLINIC
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87108-5153
Country	:	US
Telephone Number	:	505-846-0001
Fax Number	:	505-853-6290

Provider Business Practice Location Address
First Line	:	8934 CONROY WINDERMERE RD
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32835-3128
Country	:	US
Telephone Number	:	407-351-0082
Fax Number	:	407-374-1637

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

Provider Enumeration Date	:	09/21/2005
Last Update Date	:	05/31/2018

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