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NPI Code Detail

MEDICARE: MIRTZA MARTINEZ SMALL FNP-C

MEDICARE: MIRTZA MARTINEZ SMALL FNP-C
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363LF0000XFamily Nurse Practitioner224799LA

General Provider Information

NPI Number : 1164164661
Entity Type Code : Individual
Provider Name (Legal Business Name) : MIRTZA MARTINEZ SMALL FNP-C
Provider Business Mailing Address
First Line : 315 WESTBANK EXPY
Second Line :
City : GRETNA
State : LA
Zip : 70053-5616
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 501 ROBERT BLVD
Second Line :
City : SLIDELL
State : LA
Zip : 70458-1667
Country : US
Telephone Number : 866-530-6111
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/13/2022
Last Update Date : 01/13/2023

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