Provider Demographics
NPI:1760145015
Name:MARTINEZ, HARLEY SAMANTHA
Entity Type:Individual
Prefix:
First Name:HARLEY
Middle Name:SAMANTHA
Last Name:MARTINEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1309 CARLSBAD DR
Mailing Address - Street 2:
Mailing Address - City:FORNEY
Mailing Address - State:TX
Mailing Address - Zip Code:75126-0708
Mailing Address - Country:US
Mailing Address - Phone:469-355-4952
Mailing Address - Fax:
Practice Address - Street 1:1309 CARLSBAD DR
Practice Address - Street 2:
Practice Address - City:FORNEY
Practice Address - State:TX
Practice Address - Zip Code:75126-0708
Practice Address - Country:US
Practice Address - Phone:469-355-4952
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-14
Last Update Date:2021-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX939448163WM0705X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WM0705XNursing Service ProvidersRegistered NurseMedical-Surgical