Provider Demographics
NPI:1447284302
Name:MARTINEZ, SOFIA MONTOYA (ARNP)
Entity type:Individual
Prefix:MRS
First Name:SOFIA
Middle Name:MONTOYA
Last Name:MARTINEZ
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13110 ELK MOUNTAIN DR
Mailing Address - Street 2:
Mailing Address - City:RIVERVIEW
Mailing Address - State:FL
Mailing Address - Zip Code:33579-7182
Mailing Address - Country:US
Mailing Address - Phone:813-349-7568
Mailing Address - Fax:813-349-7561
Practice Address - Street 1:502 N MOBLEY ST
Practice Address - Street 2:
Practice Address - City:PLANT CITY
Practice Address - State:FL
Practice Address - Zip Code:33563-2904
Practice Address - Country:US
Practice Address - Phone:813-341-7450
Practice Address - Fax:813-341-7461
Is Sole Proprietor?:No
Enumeration Date:2006-07-10
Last Update Date:2012-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP2853362363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL302418100Medicaid
E7270ZMedicare ID - Type Unspecified
P56705Medicare UPIN