Provider Demographics
NPI:1477142636
Name:MARTINEZ, JAZZSMEN NICOLE (CPHT)
Entity Type:Individual
Prefix:
First Name:JAZZSMEN
Middle Name:NICOLE
Last Name:MARTINEZ
Suffix:
Gender:F
Credentials:CPHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 CARLOS G PARKER BLVD NW STE 101
Mailing Address - Street 2:
Mailing Address - City:TAYLOR
Mailing Address - State:TX
Mailing Address - Zip Code:76574-7059
Mailing Address - Country:US
Mailing Address - Phone:512-352-2024
Mailing Address - Fax:
Practice Address - Street 1:100 CARLOS G PARKER BLVD NW STE 101
Practice Address - Street 2:
Practice Address - City:TAYLOR
Practice Address - State:TX
Practice Address - Zip Code:76574-7059
Practice Address - Country:US
Practice Address - Phone:512-352-2024
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-01-12
Last Update Date:2021-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician