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NPI Code Detail

MEDICARE: MRS. MARCY OLIVIA MARTINEZ FNP

MEDICARE: MRS. MARCY OLIVIA MARTINEZ FNP
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 Practitioner746212TX

General Provider Information

NPI Number : 1184976748
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. MARCY OLIVIA MARTINEZ FNP
Provider Business Mailing Address
First Line : 2501 JIMMY JOHNSON BLVD.
Second Line : SUITE 501
City : PORT ARTHUR
State : TX
Zip : 77640-2013
Country : US
Telephone Number : 409-729-2555
Fax Number : 409-729-2604
Provider Business Practice Location Address
First Line : 2501 JIMMY JOHNSON BLVD.
Second Line : SUITE 501
City : PORT ARTHUR
State : TX
Zip : 77640-2013
Country : US
Telephone Number : 409-729-2555
Fax Number : 409-729-2604
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/08/2012
Last Update Date : 10/08/2012

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