Provider Demographics
NPI:1588006308
Name:MARTINEZ, ROSA AMADA (MSN, FNP-BC)
Entity Type:Individual
Prefix:
First Name:ROSA
Middle Name:AMADA
Last Name:MARTINEZ
Suffix:
Gender:F
Credentials:MSN, FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7841 ARMSTRONG DR
Mailing Address - Street 2:
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78413-6214
Mailing Address - Country:US
Mailing Address - Phone:361-221-9345
Mailing Address - Fax:
Practice Address - Street 1:4458 S STAPLES ST
Practice Address - Street 2:
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78411-2602
Practice Address - Country:US
Practice Address - Phone:361-452-9320
Practice Address - Fax:361-452-9321
Is Sole Proprietor?:No
Enumeration Date:2013-07-22
Last Update Date:2019-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX684446363LF0000X
TXAP123964363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXAP123964OtherFNP LICENSE #
TX362476903Medicaid