Provider Demographics
NPI:1720235864
Name:MARTINEZ, SALLY TEADT (FNP-BC, DNP)
Entity Type:Individual
Prefix:
First Name:SALLY
Middle Name:TEADT
Last Name:MARTINEZ
Suffix:
Gender:F
Credentials:FNP-BC, DNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1415 NW 23RD AVE
Mailing Address - Street 2:
Mailing Address - City:CHIEFLAND
Mailing Address - State:FL
Mailing Address - Zip Code:32626-1976
Mailing Address - Country:US
Mailing Address - Phone:352-493-9393
Mailing Address - Fax:352-493-9390
Practice Address - Street 1:1415 NW 23RD AVE
Practice Address - Street 2:
Practice Address - City:CHIEFLAND
Practice Address - State:FL
Practice Address - Zip Code:32626-1976
Practice Address - Country:US
Practice Address - Phone:352-493-9393
Practice Address - Fax:352-493-9390
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-20
Last Update Date:2022-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP2745582163WP0807X, 363LF0000X
FLARNP27745582363LX0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163WP0807XNursing Service ProvidersRegistered NursePsychiatric/Mental Health, Child & Adolescent
No363LX0001XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerObstetrics & Gynecology