Provider Demographics
NPI:1609402072
Name:MARTINEZ, MELANIE LYNN (DNP, APNP, CPNP-PC)
Entity Type:Individual
Prefix:MRS
First Name:MELANIE
Middle Name:LYNN
Last Name:MARTINEZ
Suffix:
Gender:F
Credentials:DNP, APNP, CPNP-PC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10462 SPRUCE PINE CT
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33913-8848
Mailing Address - Country:US
Mailing Address - Phone:630-863-2856
Mailing Address - Fax:
Practice Address - Street 1:12748 UNIVERSITY DR
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33907-5634
Practice Address - Country:US
Practice Address - Phone:239-437-5500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-03-18
Last Update Date:2022-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI9971-33363LP0200X
FLAPRN11018360363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics