Provider Demographics
NPI:1538793203
Name:FRANCISCO-MARTINBORO, SHATARA
Entity type:Individual
Prefix:
First Name:SHATARA
Middle Name:
Last Name:FRANCISCO-MARTINBORO
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 1:1150 N 35TH AVE STE 460
Mailing Address - Street 2:
Mailing Address - City:HOLLYWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:33021-5430
Mailing Address - Country:US
Mailing Address - Phone:954-265-9701
Mailing Address - Fax:954-265-8373
Practice Address - Street 1:1150 N 35TH AVE STE 460
Practice Address - Street 2:
Practice Address - City:HOLLYWOOD
Practice Address - State:FL
Practice Address - Zip Code:33021-5430
Practice Address - Country:US
Practice Address - Phone:954-265-9701
Practice Address - Fax:954-265-8373
Is Sole Proprietor?:No
Enumeration Date:2020-03-02
Last Update Date:2023-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9112676363A00000X
363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant