Provider Demographics
NPI:1154498285
Name:MARTINEZ-MENDEZ, TRACEY (DNP)
Entity Type:Individual
Prefix:MS
First Name:TRACEY
Middle Name:
Last Name:MARTINEZ-MENDEZ
Suffix:
Gender:F
Credentials:DNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:501 N YARBROUGH DR STE A
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79915-3282
Mailing Address - Country:US
Mailing Address - Phone:915-401-8999
Mailing Address - Fax:888-658-3640
Practice Address - Street 1:7430 REMCON CIR BLDG B
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79912-3525
Practice Address - Country:US
Practice Address - Phone:915-401-8999
Practice Address - Fax:888-658-3640
Is Sole Proprietor?:No
Enumeration Date:2006-11-30
Last Update Date:2022-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP115412363LF0000X, 363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX187726801Medicaid
313435YMVUOtherWNI
TX187726804Medicaid
313435YMVUOtherWNI
TXTXB159053OtherWELLMED PTAN