MEDICARE: MRS. LIZBETH MARTIN PA-C

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	363A00000X	Physician Assistant	2216	GA
2	363A00000X	Physician Assistant	PA9106466	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	:	1942586771
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. LIZBETH MARTIN PA-C

Provider Business Mailing Address
First Line	:	3131 INNOVATION DR
Second Line	:
City	:	SAINT CLOUD
State	:	FL
Zip	:	34769-6501
Country	:	US
Telephone Number	:	407-498-0071
Fax Number	:	407-498-0073

Provider Business Practice Location Address
First Line	:	3131 INNOVATION DR
Second Line	:
City	:	SAINT CLOUD
State	:	FL
Zip	:	34769-6501
Country	:	US
Telephone Number	:	407-498-0071
Fax Number	:	407-498-0073

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

Provider Enumeration Date	:	10/25/2011
Last Update Date	:	07/09/2021

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