MEDICARE: MRS. IZAMARA ISABEL MARTINEZ GUTIERREZ APRN

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
1	363LF0000X	Family Nurse Practitioner	11040526	FL
2	104100000X	Social Worker	CBHCM104470	FL

General Provider Information

NPI Number	:	1376275313
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. IZAMARA ISABEL MARTINEZ GUTIERREZ APRN

Provider Business Mailing Address
First Line	:	1680 W 60TH ST APT 1
Second Line	:
City	:	HIALEAH
State	:	FL
Zip	:	33012-6816
Country	:	US
Telephone Number	:	786-740-9653
Fax Number	:

Provider Business Practice Location Address
First Line	:	1680 W 60TH ST APT 1
Second Line	:
City	:	HIALEAH
State	:	FL
Zip	:	33012-6816
Country	:	US
Telephone Number	:	786-740-9653
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/28/2022
Last Update Date	:	01/13/2026

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