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: 06/23/2026
Certification Date: 06/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6600 UNIVERSITY PKWY STE 204
LAKEWOOD RANCH FL
34240-9041
US

IV. Provider business mailing address

PO BOX 25487
SARASOTA FL
34277-2487
US

V. Phone/Fax

Practice location:
  • Phone: 813-269-6426
  • Fax:
Mailing address:
  • Phone: 941-487-6235
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number11017554
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code163WX0200X
TaxonomyOncology Registered Nurse
License Number11017554
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: