Healthcare Provider Details

I. General information

NPI: 1609133982
Provider Name (Legal Business Name): KAREN MARTINEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/11/2012
Last Update Date: 02/24/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 SW ARCHER RD BOX 100296 RM HD513
GAINESVILLE FL
32610-0001
US

IV. Provider business mailing address

1600 SW ARCHER RD BOX 100296 RM HD513
GAINESVILLE FL
32610-0001
US

V. Phone/Fax

Practice location:
  • Phone: 352-392-0627
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberME123473
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: