Healthcare Provider Details

I. General information

NPI: 1720235864
Provider Name (Legal Business Name): SALLY TEADT MARTINEZ FNP-BC, DNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/20/2008
Last Update Date: 12/17/2025
Certification Date: 12/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

110 E PARK AVE
CHIEFLAND FL
32626-0901
US

IV. Provider business mailing address

110 E PARK AVE
CHIEFLAND FL
32626-0901
US

V. Phone/Fax

Practice location:
  • Phone: 352-339-8981
  • Fax: 352-754-3305
Mailing address:
  • Phone: 352-339-8981
  • Fax: 352-754-3305

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WP0807X
TaxonomyChild & Adolescent Psychiatric/Mental Health Registered Nurse
License NumberARNP2745582
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberARNP2745582
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: