Healthcare Provider Details

I. General information

NPI: 1205470598
Provider Name (Legal Business Name): DANYASHAE MARTINEZ PMHP-BC, FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/30/2019
Last Update Date: 04/04/2025
Certification Date: 04/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

605 N GILBERT RD
MESA AZ
85203-6629
US

IV. Provider business mailing address

605 N GILBERT RD
MESA AZ
85203-6629
US

V. Phone/Fax

Practice location:
  • Phone: 800-905-6419
  • Fax: 602-932-5846
Mailing address:
  • Phone: 602-848-4834
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number264385
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number264385
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: