Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 363LP0200X | Nurse Practitioner - Pediatrics | 423106 | CA |
Y | 363LP0200X | Nurse Practitioner - Pediatrics | ARNP 9215632 | FL |
NPI | 1033174735 |
---|---|
Provider Name | Elizabeth Ann Marks De Martino |
First Address | Morriston, FL 32668-3959 |
Second Address | Ocala, FL 34471-5532 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/04/2006 |
Last Update Date | 30/06/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
306491300 | (05) | FL |