Provider Demographics
NPI:1316563786
Name:MARTINEZ HERNANDEZ, AQUILES SALVADOR (FNP-C)
Entity Type:Individual
Prefix:
First Name:AQUILES
Middle Name:SALVADOR
Last Name:MARTINEZ HERNANDEZ
Suffix:
Gender:M
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1456 E PECOS RD APT 2034
Mailing Address - Street 2:
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85295-1780
Mailing Address - Country:US
Mailing Address - Phone:540-514-6069
Mailing Address - Fax:
Practice Address - Street 1:1456 E PECOS RD APT 2034
Practice Address - Street 2:
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85295-1780
Practice Address - Country:US
Practice Address - Phone:540-514-6069
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-22
Last Update Date:2024-03-20
Deactivation Date:2024-03-12
Deactivation Code:
Reactivation Date:2024-03-20
Provider Licenses
StateLicense IDTaxonomies
FL11031795363LF0000X
WI20-271246ZC0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant