Provider Demographics
NPI:1558411298
Name:MARTINEZ, SHARON ANN (RNCNP)
Entity Type:Individual
Prefix:
First Name:SHARON
Middle Name:ANN
Last Name:MARTINEZ
Suffix:
Gender:F
Credentials:RNCNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1626 E KIOWA ST
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80909-5617
Mailing Address - Country:US
Mailing Address - Phone:719-635-4974
Mailing Address - Fax:
Practice Address - Street 1:301 S UNION BLVD
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80910-3123
Practice Address - Country:US
Practice Address - Phone:719-575-8509
Practice Address - Fax:719-578-3114
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COCO41959363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO07419591Medicaid