Provider Demographics
NPI:1518588367
Name:MARTIN, ANTHONY RONNY (APRN, CNS)
Entity type:Individual
Prefix:
First Name:ANTHONY
Middle Name:RONNY
Last Name:MARTIN
Suffix:
Gender:M
Credentials:APRN, CNS
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Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:8270 NW 83RD ST
Mailing Address - Street 2:
Mailing Address - City:TAMARAC
Mailing Address - State:FL
Mailing Address - Zip Code:33321-1755
Mailing Address - Country:US
Mailing Address - Phone:954-422-6777
Mailing Address - Fax:
Practice Address - Street 1:1505 EASTLAND DR STE 320
Practice Address - Street 2:
Practice Address - City:BLOOMINGTON
Practice Address - State:IL
Practice Address - Zip Code:61701-7912
Practice Address - Country:US
Practice Address - Phone:309-661-2368
Practice Address - Fax:309-662-9709
Is Sole Proprietor?:Yes
Enumeration Date:2020-05-04
Last Update Date:2025-08-13
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CT011624363LA2100X, 363LG0600X, 363LG0600X
FL11006843363LA2100X
FLAPRN11006843363LG0600X, 363LG0600X
IL209029057363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
No363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care