Individual
DESHAE MARTIN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
NURSE PRACTITIONER
Contact information
Practice address
110 LITHIA PINECREST RD STE B, BRANDON, FL 33511-5300
(813) 679-5122
Mailing address
2105 ROANOKE SPRINGS DR, RUSKIN, FL 33570-6312
(813) 585-7708
Taxonomy
Speciality
Code
Description
License number
State
207RI0001X
Clinical & Laboratory Immunology (Internal Medicine) Physician
9303768
FL
363LA2100X
Acute Care Nurse Practitioner
9303768
FL
363LC1500X
Community Health Nurse Practitioner
Primary
9303768
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
019436600
—
FL
Enumeration date
07/27/2016
Last updated
08/16/2021
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