Provider Demographics
NPI:1184976748
Name:MARTINEZ, MARCY OLIVIA (FNP)
Entity type:Individual
Prefix:MRS
First Name:MARCY
Middle Name:OLIVIA
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 1:2501 JIMMY JOHNSON BLVD.
Mailing Address - Street 2:SUITE 501
Mailing Address - City:PORT ARTHUR
Mailing Address - State:TX
Mailing Address - Zip Code:77640-2013
Mailing Address - Country:US
Mailing Address - Phone:409-729-2555
Mailing Address - Fax:409-729-2604
Practice Address - Street 1:2501 JIMMY JOHNSON BLVD.
Practice Address - Street 2:SUITE 501
Practice Address - City:PORT ARTHUR
Practice Address - State:TX
Practice Address - Zip Code:77640-2013
Practice Address - Country:US
Practice Address - Phone:409-729-2555
Practice Address - Fax:409-729-2604
Is Sole Proprietor?:No
Enumeration Date:2012-10-08
Last Update Date:2012-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX746212363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily