Healthcare Provider Details

I. General information

NPI: 1588255574
Provider Name (Legal Business Name): ELISE CORY MARTINEZ NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ELISE CORY RODRIGUEZ NP

II. Dates (important events)

Enumeration Date: 02/01/2021
Last Update Date: 09/10/2025
Certification Date: 09/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8925 COLONIAL CENTER DR STE 2001
FORT MYERS FL
33905-7813
US

IV. Provider business mailing address

PO BOX 2147
FORT MYERS FL
33902-2147
US

V. Phone/Fax

Practice location:
  • Phone: 239-343-9567
  • Fax: 239-343-9571
Mailing address:
  • Phone: 239-343-9567
  • Fax: 239-343-9571

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WX0200X
TaxonomyOncology Registered Nurse
License Number247724
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number5014029
License Number StateNC
# 3
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN11016007
License Number StateFL
# 4
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAPRN11016007
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: