Provider Demographics
NPI:1578058053
Name:MARTINEZ, JUVENAL (ARNP)
Entity Type:Individual
Prefix:
First Name:JUVENAL
Middle Name:
Last Name:MARTINEZ
Suffix:
Gender:M
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10550 NW 77TH CT
Mailing Address - Street 2:STE 308
Mailing Address - City:HIALEAH GARDENS
Mailing Address - State:FL
Mailing Address - Zip Code:33016-2072
Mailing Address - Country:US
Mailing Address - Phone:305-896-7328
Mailing Address - Fax:
Practice Address - Street 1:7668 SW 152ND AVE APT 103
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33193-1130
Practice Address - Country:US
Practice Address - Phone:305-896-7328
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-26
Last Update Date:2018-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9430763363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily