Provider Demographics
NPI:1700874047
Name:MARTINEZ, DONNA K (NP)
Entity Type:Individual
Prefix:
First Name:DONNA
Middle Name:K
Last Name:MARTINEZ
Suffix:
Gender:F
Credentials:NP
Other - Prefix:MS
Other - First Name:DONNA MARIE
Other - Middle Name:KEY
Other - Last Name:THOMPSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSN ARNP BC
Mailing Address - Street 1:2345 SAND LAKE RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32809-9142
Mailing Address - Country:US
Mailing Address - Phone:407-851-5121
Mailing Address - Fax:407-851-0439
Practice Address - Street 1:2345 SAND LAKE RD
Practice Address - Street 2:SUITE 200
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32809-9142
Practice Address - Country:US
Practice Address - Phone:407-851-5121
Practice Address - Fax:407-851-0439
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-11
Last Update Date:2013-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP3199502363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL072605OtherAARP
E8109Medicare PIN