Provider Demographics
NPI:1205206836
Name:MARTIN, PAULETTE GONZALEZ (FNP)
Entity Type:Individual
Prefix:
First Name:PAULETTE
Middle Name:GONZALEZ
Last Name:MARTIN
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:PAULETTE
Other - Middle Name:MILAGROS
Other - Last Name:GONZALEZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP
Mailing Address - Street 1:1316 CORNELL PL
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27607-6024
Mailing Address - Country:US
Mailing Address - Phone:954-410-3334
Mailing Address - Fax:
Practice Address - Street 1:10880 DURANT RD STE 215
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27614-6629
Practice Address - Country:US
Practice Address - Phone:919-205-4410
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-09-24
Last Update Date:2020-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC243970363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily