Provider Demographics
NPI:1659693158
Name:MARTINEZ, VIVIANA (RN)
Entity Type:Individual
Prefix:
First Name:VIVIANA
Middle Name:
Last Name:MARTINEZ
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:215 HORSTFIELD DR
Mailing Address - Street 2:
Mailing Address - City:WINTER GARDEN
Mailing Address - State:FL
Mailing Address - Zip Code:34787-6068
Mailing Address - Country:US
Mailing Address - Phone:407-414-0159
Mailing Address - Fax:
Practice Address - Street 1:1609 E VINE ST
Practice Address - Street 2:
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34744-3733
Practice Address - Country:US
Practice Address - Phone:407-847-4152
Practice Address - Fax:407-847-0700
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-24
Last Update Date:2023-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR29532163WG0000X
FL171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice