Healthcare Provider Details

I. General information

NPI: 1063299113
Provider Name (Legal Business Name): ITZEL MARTINEZ FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/12/2023
Last Update Date: 03/05/2024
Certification Date: 03/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

899 N WILMOT RD STE B
TUCSON AZ
85711-1712
US

IV. Provider business mailing address

PO BOX 188
MARANA AZ
85653-0188
US

V. Phone/Fax

Practice location:
  • Phone: 520-290-1100
  • Fax: 520-290-8997
Mailing address:
  • Phone: 520-290-1100
  • Fax: 520-290-8997

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number297578
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: