Provider Demographics
NPI:1598275885
Name:MARTINEZ, EZEQUIEL EMILIANO (ARNP)
Entity Type:Individual
Prefix:MR
First Name:EZEQUIEL
Middle Name:EMILIANO
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 1:1313 RED PONY RANCH RD
Mailing Address - Street 2:
Mailing Address - City:DELAND
Mailing Address - State:FL
Mailing Address - Zip Code:32724-7987
Mailing Address - Country:US
Mailing Address - Phone:407-617-8348
Mailing Address - Fax:
Practice Address - Street 1:11600 LAKESIDE VILLAGE LN
Practice Address - Street 2:
Practice Address - City:WINDERMERE
Practice Address - State:FL
Practice Address - Zip Code:34786-7024
Practice Address - Country:US
Practice Address - Phone:407-876-2273
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-10-02
Last Update Date:2017-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9386890363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily