Provider Demographics
NPI:1790016798
Name:MARTINEZ, GLORIA INEZ (CRNA)
Entity Type:Individual
Prefix:
First Name:GLORIA
Middle Name:INEZ
Last Name:MARTINEZ
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:700 HIGHLANDER BLVD STE 415
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76015-4346
Mailing Address - Country:US
Mailing Address - Phone:817-516-8811
Mailing Address - Fax:817-877-0350
Practice Address - Street 1:6404 JUNEAU RD
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76116-1616
Practice Address - Country:US
Practice Address - Phone:817-797-9980
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-01-15
Last Update Date:2020-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX684916367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered