Provider Demographics
NPI:1073376133
Name:MARTINEZ, VIANEY (APRN)
Entity Type:Individual
Prefix:
First Name:VIANEY
Middle Name:
Last Name:MARTINEZ
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:496 LAKE COMO DR
Mailing Address - Street 2:
Mailing Address - City:POMONA PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32181-2410
Mailing Address - Country:US
Mailing Address - Phone:386-315-3091
Mailing Address - Fax:
Practice Address - Street 1:496 LAKE COMO DR
Practice Address - Street 2:
Practice Address - City:POMONA PARK
Practice Address - State:FL
Practice Address - Zip Code:32181-2410
Practice Address - Country:US
Practice Address - Phone:386-315-3091
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-02-01
Last Update Date:2024-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11030277363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily