Provider Demographics
NPI:1053685396
Name:MARTINEZ, TAMARA DANETT (LPN)
Entity Type:Individual
Prefix:
First Name:TAMARA
Middle Name:DANETT
Last Name:MARTINEZ
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:TAMARA
Other - Middle Name:DANETT
Other - Last Name:DELGADILLO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LPN
Mailing Address - Street 1:1132 E 12TH ST
Mailing Address - Street 2:
Mailing Address - City:DOUGLAS
Mailing Address - State:AZ
Mailing Address - Zip Code:85607-2337
Mailing Address - Country:US
Mailing Address - Phone:520-364-2447
Mailing Address - Fax:520-224-2475
Practice Address - Street 1:1500 E 15TH ST
Practice Address - Street 2:
Practice Address - City:DOUGLAS
Practice Address - State:AZ
Practice Address - Zip Code:85607-1731
Practice Address - Country:US
Practice Address - Phone:520-364-3462
Practice Address - Fax:520-805-4171
Is Sole Proprietor?:No
Enumeration Date:2012-03-05
Last Update Date:2012-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLP043706164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse