Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 224P00000X | Prosthetist | PN514280 | FL |
NPI | 1255963450 |
---|---|
Provider Name | Tyshawn Martin |
First Address | Hollywood, FL 33021-8023 |
Second Address | Hollywood, FL 33021-8023 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 06/02/2020 |
Last Update Date | 06/02/2020 |