Individual
JANE MARTI MARTIN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
240 N FREDERICK AVE, DAYTONA BEACH, FL 32114-3400
(386) 255-5569
(386) 255-5277
Mailing address
240 N FREDERICK AVE, DAYTONA BEACH, FL 32114-3400
(386) 255-5569
(386) 255-5277
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
010728100
PROVIDER MEDICAID NUMBER
FL
Enumeration date
06/04/2014
Last updated
06/04/2014
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