Provider Demographics
NPI:1649541681
Name:MARTINEZ, MARIBEL (FNP)
Entity type:Individual
Prefix:
First Name:MARIBEL
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 1:600 RIDGE CREST DR
Mailing Address - Street 2:
Mailing Address - City:ROUND ROCK
Mailing Address - State:TX
Mailing Address - Zip Code:78664-5949
Mailing Address - Country:US
Mailing Address - Phone:956-457-3900
Mailing Address - Fax:
Practice Address - Street 1:7901 CAMERON RD STE 105
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78754-3831
Practice Address - Country:US
Practice Address - Phone:512-617-4142
Practice Address - Fax:512-617-4146
Is Sole Proprietor?:No
Enumeration Date:2012-01-23
Last Update Date:2014-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX667557363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily