Basic Information
| Provider Information | |||||||||
| NPI: | 1730843533 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MARTINEZ-BOOKER | ||||||||
| FirstName: | MIA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4315 HIGHLAND PARK BLVD STE A | ||||||||
| Address2: | |||||||||
| City: | LAKELAND | ||||||||
| State: | FL | ||||||||
| PostalCode: | 338131639 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8638165884 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 4315 HIGHLAND PARK BLVD STE A | ||||||||
| Address2: | |||||||||
| City: | LAKELAND | ||||||||
| State: | FL | ||||||||
| PostalCode: | 338131639 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8638165884 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/27/2021 | ||||||||
| LastUpdateDate: | 10/27/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 10/27/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | APRN11015946 | FL | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No ID Information.