Provider Demographics
NPI:1790239168
Name:MARTINEZ, JESSICA (RN, FNP-C)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:
Last Name:MARTINEZ
Suffix:
Gender:F
Credentials:RN, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:710 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:CROSBYTON
Mailing Address - State:TX
Mailing Address - Zip Code:79322-2143
Mailing Address - Country:US
Mailing Address - Phone:806-675-7382
Mailing Address - Fax:
Practice Address - Street 1:710 W MAIN ST
Practice Address - Street 2:
Practice Address - City:CROSBYTON
Practice Address - State:TX
Practice Address - Zip Code:79322-2143
Practice Address - Country:US
Practice Address - Phone:806-675-7382
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-15
Last Update Date:2016-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP131707363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily