Provider Demographics
NPI:1447793914
Name:MARTINEZ, IDELIS (ARNP)
Entity Type:Individual
Prefix:
First Name:IDELIS
Middle Name:
Last Name:MARTINEZ
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4131 SW 6TH ST
Mailing Address - Street 2:
Mailing Address - City:CORAL GABLES
Mailing Address - State:FL
Mailing Address - Zip Code:33134-2057
Mailing Address - Country:US
Mailing Address - Phone:786-534-4966
Mailing Address - Fax:305-290-4001
Practice Address - Street 1:4131 SW 6TH ST
Practice Address - Street 2:
Practice Address - City:CORAL GABLES
Practice Address - State:FL
Practice Address - Zip Code:33134-2057
Practice Address - Country:US
Practice Address - Phone:786-534-4966
Practice Address - Fax:305-290-4001
Is Sole Proprietor?:No
Enumeration Date:2016-11-30
Last Update Date:2018-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9350398363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily