Provider Demographics
NPI:1326424953
Name:MARTINEZ, GRECIA VANESSA (FNP)
Entity Type:Individual
Prefix:
First Name:GRECIA
Middle Name:VANESSA
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 1:801 S MAIN ST
Mailing Address - Street 2:STE C
Mailing Address - City:MCALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:78501-5055
Mailing Address - Country:US
Mailing Address - Phone:956-686-0574
Mailing Address - Fax:956-686-3301
Practice Address - Street 1:801 S MAIN ST
Practice Address - Street 2:STE C
Practice Address - City:MCALLEN
Practice Address - State:TX
Practice Address - Zip Code:78501-5055
Practice Address - Country:US
Practice Address - Phone:956-686-0574
Practice Address - Fax:956-686-3301
Is Sole Proprietor?:No
Enumeration Date:2015-08-05
Last Update Date:2016-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP128728363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX439369YLPSOtherWELLMED PTAN