Provider Demographics
NPI:1235957440
Name:MARTINEZ, JOHANNA (NURSE PRACTITIONER)
Entity type:Individual
Prefix:MRS
First Name:JOHANNA
Middle Name:
Last Name:MARTINEZ
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:JOHANNA
Other - Middle Name:
Other - Last Name:PENA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:389 MORGAN AVENUE APT 7B
Mailing Address - Street 2:
Mailing Address - City:BLKYN
Mailing Address - State:NY
Mailing Address - Zip Code:11211-1686
Mailing Address - Country:US
Mailing Address - Phone:718-809-0980
Mailing Address - Fax:
Practice Address - Street 1:100 EAST 77TH STREET
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10075
Practice Address - Country:US
Practice Address - Phone:212-434-2660
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-27
Last Update Date:2024-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY354945363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily