DESHAE MARTIN NURSE PRACTITIONER NPI 1861945719

NPI Information

NPI: 1861945719
Provider Name: DESHAE MARTIN, NURSE PRACTITIONER
Classification: Nurse Practitioner - 363LC1500X
Entity Type: Individual

Specialization: Community Health

PECOS Registration: Yes

Address:
110 LITHIA PINECREST RD STE B
BRANDON, FL
ZIP 33511
Phone: (813) 679-5122
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Deshae Martin, NURSE PRACTITIONER is a community health nurse practitioner in Brandon, FL. Deshae Martin, NURSE PRACTITIONER NPI is 1861945719. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a female.

The provider's business location address is:

110 LITHIA PINECREST RD STE B
BRANDON, FL
ZIP 33511-300
Phone: (813) 679-5122

The NPI 1861945719 is registered in the Medicare Provider, Enrollment, Chain and Ownership System (PECOS). The provider is legally eligible to order and refer Part B (Clinical Laboratory and Imaging), Durable Medical Equipment, Part A Home Health Agency (HHA), Power Mobility Devices.

The enumeration date for this NPI number is 7/27/2016 and was last updated on 8/16/2021.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	363LA2100X	Nurse Practitioner	Acute Care	9303768	FLORIDA	No
2	363LC1500X	Nurse Practitioner	Community Health	9303768	FLORIDA	Yes
3	207RI0001X	Internal Medicine	Clinical & Laboratory Immunology	9303768	FLORIDA	No

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	019436600	MEDICAID	FLORIDA

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/14/2023

NPI Synchronization or Removal

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