Provider Demographics
NPI:1679026371
Name:MARTINEZ, JENNIFER JOAN (FNP-BC)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:JOAN
Last Name:MARTINEZ
Suffix:
Gender:F
Credentials: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:PO BOX 237
Mailing Address - Street 2:
Mailing Address - City:EL RITO
Mailing Address - State:NM
Mailing Address - Zip Code:87530-0237
Mailing Address - Country:US
Mailing Address - Phone:505-685-4479
Mailing Address - Fax:
Practice Address - Street 1:NM 571 BLDG 28
Practice Address - Street 2:
Practice Address - City:EL RITO
Practice Address - State:NM
Practice Address - Zip Code:87530
Practice Address - Country:US
Practice Address - Phone:505-685-4479
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-07-28
Last Update Date:2016-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMCNP-02978363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily