Provider Demographics
NPI:1518674753
Name:MARTIN, TANIA MILDRELY (FNP)
Entity type:Individual
Prefix:MS
First Name:TANIA
Middle Name:MILDRELY
Last Name:MARTIN
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:1785 NORTHPOINTE PKWY STE 300
Mailing Address - Street 2:
Mailing Address - City:LUTZ
Mailing Address - State:FL
Mailing Address - Zip Code:33558-5742
Mailing Address - Country:US
Mailing Address - Phone:813-536-7277
Mailing Address - Fax:833-642-0635
Practice Address - Street 1:6703 38TH AVE N
Practice Address - Street 2:
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33710-1536
Practice Address - Country:US
Practice Address - Phone:727-213-5377
Practice Address - Fax:727-828-9639
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-27
Last Update Date:2024-12-04
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLAPRN11022745363LF0000X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily