Provider Demographics
NPI:1639704539
Name:MARTINEZ, ROBERT A (APRN)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:A
Last Name:MARTINEZ
Suffix:
Gender:M
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5450 CLEARFORK MAIN ST
Mailing Address - Street 2:STE 300
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76109-3514
Mailing Address - Country:US
Mailing Address - Phone:817-334-1400
Mailing Address - Fax:
Practice Address - Street 1:5450 CLEARFORK MAIN ST STE 300
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76109-3514
Practice Address - Country:US
Practice Address - Phone:817-984-1688
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-11
Last Update Date:2020-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP145045363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily