Provider Demographics
NPI:1801223102
Name:MARTINEZ, CHARLES ULICK (CRNP)
Entity type:Individual
Prefix:
First Name:CHARLES
Middle Name:ULICK
Last Name:MARTINEZ
Suffix:
Gender:M
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:8316 ARLINGTON BLVD STE 420
Mailing Address - Street 2:
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22031-5216
Mailing Address - Country:US
Mailing Address - Phone:703-520-9703
Mailing Address - Fax:703-563-9602
Practice Address - Street 1:8316 ARLINGTON BLVD STE 420
Practice Address - Street 2:
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22031-5216
Practice Address - Country:US
Practice Address - Phone:703-520-9703
Practice Address - Fax:703-520-9703
Is Sole Proprietor?:No
Enumeration Date:2013-10-01
Last Update Date:2025-10-10
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VA0024173453363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily