Provider Demographics
NPI:1811904634
Name:MARTINEZ, ELENA MARIA (WHNP-BC)
Entity type:Individual
Prefix:MRS
First Name:ELENA
Middle Name:MARIA
Last Name:MARTINEZ
Suffix:
Gender:F
Credentials:WHNP-BC
Other - Prefix:MS
Other - First Name:ELENA
Other - Middle Name:MARIA
Other - Last Name:GUTIERREZ
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:WHNP-BC
Mailing Address - Street 1:2332 BEVERLY HILLS DR
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76114-1756
Mailing Address - Country:US
Mailing Address - Phone:817-378-0855
Mailing Address - Fax:817-378-0861
Practice Address - Street 1:2332 BEVERLY HILLS DR
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76114-1756
Practice Address - Country:US
Practice Address - Phone:817-378-0855
Practice Address - Fax:817-378-0861
Is Sole Proprietor?:No
Enumeration Date:2006-08-02
Last Update Date:2020-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX738892363LX0001X
TXAP115715363LX0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LX0001XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
953086389Medicare UPIN
W2940AMedicare ID - Type Unspecified