Provider Demographics
NPI:1902448228
Name:GARCIA MARTIN, AMILYS
Entity Type:Individual
Prefix:
First Name:AMILYS
Middle Name:
Last Name:GARCIA MARTIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1441 ANNA CATHERINE DR
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32828-7407
Mailing Address - Country:US
Mailing Address - Phone:407-969-1964
Mailing Address - Fax:
Practice Address - Street 1:1140 S SEMORAN BLVD STE E
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32807-1459
Practice Address - Country:US
Practice Address - Phone:407-384-9165
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-10-09
Last Update Date:2022-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11004867363L00000X
FLME90674208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLG625000785070OtherDRIVERS LICENSE