Provider Demographics
NPI:1659181980
Name:AMORTEGUI HERRERA, MARTHA JANNETH
Entity type:Individual
Prefix:
First Name:MARTHA
Middle Name:JANNETH
Last Name:AMORTEGUI HERRERA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4939 NW 84TH AVE
Mailing Address - Street 2:
Mailing Address - City:DORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33166-5890
Mailing Address - Country:US
Mailing Address - Phone:786-422-3855
Mailing Address - Fax:
Practice Address - Street 1:4939 NW 84TH AVE
Practice Address - Street 2:
Practice Address - City:DORAL
Practice Address - State:FL
Practice Address - Zip Code:33166-5890
Practice Address - Country:US
Practice Address - Phone:786-422-3855
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-01-09
Last Update Date:2025-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLF11240764363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily