Healthcare Provider Details

I. General information

NPI: 1720629892
Provider Name (Legal Business Name): STEPHANIE MARTINEZ ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/30/2019
Last Update Date: 12/30/2021
Certification Date: 06/30/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3501 JOHNSON ST
HOLLYWOOD FL
33021-5421
US

IV. Provider business mailing address

11921 NW 31ST PL
SUNRISE FL
33323-1211
US

V. Phone/Fax

Practice location:
  • Phone: 954-265-4850
  • Fax:
Mailing address:
  • Phone: 646-267-9315
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WX0200X
TaxonomyOncology Registered Nurse
License Number9441018
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number9441018
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: