Provider Demographics
NPI:1457634529
Name:STREB-MARTINEZ, JESSICA M (GNP-BC)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:M
Last Name:STREB-MARTINEZ
Suffix:
Gender:F
Credentials:GNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7330 SAN PEDRO AVE STE 540
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78216-6250
Mailing Address - Country:US
Mailing Address - Phone:210-344-2673
Mailing Address - Fax:
Practice Address - Street 1:7330 SAN PEDRO AVE STE 540
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78216-6250
Practice Address - Country:US
Practice Address - Phone:210-344-2673
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-09-24
Last Update Date:2018-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP120887363LG0600X
TX762104363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX321325YLGGMedicare PIN