Provider Demographics
NPI:1023682770
Name:DOMOND, MARTIN (RN)
Entity type:Individual
Prefix:
First Name:MARTIN
Middle Name:
Last Name:DOMOND
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:900 LINTON BLVD STE 202
Mailing Address - Street 2:
Mailing Address - City:DELRAY BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33444-8165
Mailing Address - Country:US
Mailing Address - Phone:954-683-4394
Mailing Address - Fax:
Practice Address - Street 1:900 LINTON BLVD STE 202
Practice Address - Street 2:
Practice Address - City:DELRAY BEACH
Practice Address - State:FL
Practice Address - Zip Code:33444-8165
Practice Address - Country:US
Practice Address - Phone:954-683-4394
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-05-18
Last Update Date:2021-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9184414163WG0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice