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Individual provider Active NPI

Martha N Cullen, APRN

  • Adult Health Nurse Practitioner
  • Orange City, FL
National Provider Identifier
1972690972
Registry record updated Oct 28, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Adult Health Nurse PractitionerTaxonomy code 363LA2200X
License
APRN1568282 Issued in FL
Practice address
701 Monastery Rd
Orange City, FL 32763
Phone
(386) 456-1600
Fax
(386) 456-1550
NPI assigned
Oct 10, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 28, 2022

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Adult Health Nurse Practitioner 363LA2200X APRN1568282 FL Primary

Addresses

Primary practice location

701 Monastery Rd
Orange City, FL 32763

Mailing address

701 Monastery Rd FL 32763
Orange City, FL 32763-6222
Phone (386) 456-1600

Other identifiers 4

IdentifierTypeStateIssuer
70193OtherNMCNP LICENSE
089741-23OtherNHAPRN LICENSE
1568282OtherFLLICENSE
P00360118OtherFLRAILROAD MEDICARE

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20070110000581 FL Practitioner - Nurse Practitioner 8820098106 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2005
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

101 Northlake Dr
Orange City, FL 32763-6167
Phone (386) 775-3840

Hospital & facility affiliations

  • John Knox Village of Central Florida Inc Home health agency, Orange City, FL, CCN 107530
  • Halifax Health Hospice Hospice, Port Orange, FL, CCN 101522
  • Adventhealth Fish Memorial Hospital, Orange City, FL, CCN 100072
  • Adventhealth Deland Hospital, Deland, FL, CCN 100045
  • Majestic Oaks Nursing home, Orange City, FL, CCN 105374

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
John Knox Village of Central Florida, Inc CurrentSince Jul 17, 2012 Accepting new patients
John Knox Village of Central Florida, Inc CurrentSince Jul 17, 2012 Accepting new patients

Locations

101 Northlake Dr
Orange City, FL 32763
Phone (386) 775-3840

701 Monastery Rd
Orange City, FL 32763
Phone (386) 456-1600

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Hospital & facility affiliations 6

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1160438400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1666915200000",
    "number": "1972690972",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "701 MONASTERY RD FL 32763",
            "city": "ORANGE CITY",
            "state": "FL",
            "postal_code": "327636222",
            "telephone_number": "386-456-1600",
            "fax_number": "386-456-1550"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "701 MONASTERY RD",
            "city": "ORANGE CITY",
            "state": "FL",
            "postal_code": "32763",
            "telephone_number": "386-456-1600",
            "fax_number": "386-456-1550"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CULLEN",
        "first_name": "MARTHA",
        "middle_name": "N",
        "name_prefix": "Ms.",
        "credential": "APRN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-10-10",
        "last_updated": "2022-10-28",
        "certification_date": "2022-10-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LA2200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Adult Health",
            "state": "FL",
            "license": "APRN1568282",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CNP LICENSE",
            "identifier": "70193",
            "state": "NM"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "APRN LICENSE",
            "identifier": "089741-23",
            "state": "NH"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LICENSE",
            "identifier": "1568282",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "P00360118",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Orange City, FL

Sources for this page

Verify at the official NPI Registry.