Provider Demographics
NPI:1790775567
Name:MARTINEZ, EMELIN (FNP)
Entity Type:Individual
Prefix:
First Name:EMELIN
Middle Name:
Last Name:MARTINEZ
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:NORTH HIGHWAY 159
Mailing Address - Street 2:
Mailing Address - City:SAN LUIS
Mailing Address - State:CO
Mailing Address - Zip Code:81152
Mailing Address - Country:US
Mailing Address - Phone:719-672-3352
Mailing Address - Fax:719-672-3638
Practice Address - Street 1:NORTH HIGHWAY 159
Practice Address - Street 2:
Practice Address - City:SAN LUIS
Practice Address - State:CO
Practice Address - Zip Code:81152
Practice Address - Country:US
Practice Address - Phone:719-672-3352
Practice Address - Fax:719-672-3638
Is Sole Proprietor?:No
Enumeration Date:2005-10-24
Last Update Date:2011-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO66928363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
500027320OtherTRAVELERS MEDICARE
CO840706945031OtherROCKY MOUNTAIN HEALTH PLA
COA100627Medicare PIN
500027320OtherTRAVELERS MEDICARE