Provider Demographics
NPI:1174986038
Name:MARTINEZ BOHAN, OLGA EMILIA (ARNP)
Entity type:Individual
Prefix:MRS
First Name:OLGA
Middle Name:EMILIA
Last Name:MARTINEZ BOHAN
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2289 HANNAH WAY S
Mailing Address - Street 2:
Mailing Address - City:DUNEDIN
Mailing Address - State:FL
Mailing Address - Zip Code:34698-9452
Mailing Address - Country:US
Mailing Address - Phone:727-781-5976
Mailing Address - Fax:
Practice Address - Street 1:12685 STARKEY RD
Practice Address - Street 2:
Practice Address - City:LARGO
Practice Address - State:FL
Practice Address - Zip Code:33773-1421
Practice Address - Country:US
Practice Address - Phone:727-535-9901
Practice Address - Fax:727-535-8760
Is Sole Proprietor?:No
Enumeration Date:2016-03-29
Last Update Date:2016-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9339667363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL9339667OtherSTATE LICENSE NUMBER