Provider Demographics
NPI:1043602733
Name:FAUSTIN, MARTIALE (REGISTERED NURSE)
Entity type:Individual
Prefix:
First Name:MARTIALE
Middle Name:
Last Name:FAUSTIN
Suffix:
Gender:F
Credentials:REGISTERED NURSE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12715 CLOCK TOWER PKWY
Mailing Address - Street 2:
Mailing Address - City:HUDSON
Mailing Address - State:FL
Mailing Address - Zip Code:34667-2504
Mailing Address - Country:US
Mailing Address - Phone:954-274-9113
Mailing Address - Fax:866-924-5296
Practice Address - Street 1:12715 CLOCK TOWER PKWY
Practice Address - Street 2:
Practice Address - City:HUDSON
Practice Address - State:FL
Practice Address - Zip Code:34667
Practice Address - Country:US
Practice Address - Phone:954-274-9113
Practice Address - Fax:866-924-5296
Is Sole Proprietor?:No
Enumeration Date:2015-03-04
Last Update Date:2019-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRN9318479163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse