Provider Demographics
NPI:1093003105
Name:MARTINEZ, JUANITA MARIE (FNP)
Entity Type:Individual
Prefix:MRS
First Name:JUANITA
Middle Name:MARIE
Last Name:MARTINEZ
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2147
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33902-2147
Mailing Address - Country:US
Mailing Address - Phone:239-424-1449
Mailing Address - Fax:239-424-1423
Practice Address - Street 1:3501 HEALTH CENTER BLVD STE 2310
Practice Address - Street 2:
Practice Address - City:ESTERO
Practice Address - State:FL
Practice Address - Zip Code:34135-8130
Practice Address - Country:US
Practice Address - Phone:239-495-5020
Practice Address - Fax:239-495-5015
Is Sole Proprietor?:No
Enumeration Date:2011-07-11
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9419100363LF0000X
TX695949363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX283458202Medicaid
FL019960600Medicaid
TX283458201Medicaid
TX283458203Medicaid
TXP01041264OtherMEDICARE RAILROAD
TX283458201Medicaid
TX283458202Medicaid
TXTXB134225Medicare PIN