Provider Demographics
NPI:1447725056
Name:MARTINEZ, NANCY A (APRN)
Entity type:Individual
Prefix:
First Name:NANCY
Middle Name:A
Last Name:MARTINEZ
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:900 S PINE ISLAND RD STE 800
Mailing Address - Street 2:
Mailing Address - City:PLANTATION
Mailing Address - State:FL
Mailing Address - Zip Code:33324-3923
Mailing Address - Country:US
Mailing Address - Phone:305-821-8611
Mailing Address - Fax:305-827-1753
Practice Address - Street 1:15507 NW 67TH AVE
Practice Address - Street 2:
Practice Address - City:MIAMI LAKES
Practice Address - State:FL
Practice Address - Zip Code:33014-2108
Practice Address - Country:US
Practice Address - Phone:305-821-8611
Practice Address - Fax:305-821-1753
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-10
Last Update Date:2020-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN2790812363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL105119200Medicaid