Provider Demographics
NPI:1013417070
Name:MARTINEZ, ANGELISSE MARIE (NP)
Entity Type:Individual
Prefix:
First Name:ANGELISSE
Middle Name:MARIE
Last Name:MARTINEZ
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:ANGELISSE
Other - Middle Name:MARIE
Other - Last Name:AVILES TORRES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3230 HILLSDALE LN
Mailing Address - Street 2:
Mailing Address - City:KISSIMMEE
Mailing Address - State:FL
Mailing Address - Zip Code:34741-7562
Mailing Address - Country:US
Mailing Address - Phone:787-568-1506
Mailing Address - Fax:
Practice Address - Street 1:3230 HILLSDALE LN
Practice Address - Street 2:
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34741-7562
Practice Address - Country:US
Practice Address - Phone:407-785-1967
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-02-16
Last Update Date:2023-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN11006283363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care